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Moaven Z. Therapy, Spirituality, and Spiritual Well-being: A Qualitative Study of Holy Places Tourists. Health Spiritual Med Ethics 2020; 7 (1) :48-59
URL: http://jhsme.muq.ac.ir/article-1-305-en.html
URL: http://jhsme.muq.ac.ir/article-1-305-en.html
School of Economics, Management and Social Sciences, Shiraz University, Shiraz, Iran. , z.moaven5@gmail.com
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Health, Spirituality and Medical Ethics - Vol.7, No.1, Mar 2020 48
Therapy, Spirituality, and Spiritual Well-being: A Qualitative Study of Holy
Places Tourists
Received 30 May 2019; Accepted 08 Dec 2019
http://dx.doi.org/10.29252/jhsme.7.1.48
Zahra Moaven1*
1 School of Economics, Management and Social Sciences, Shiraz University, Shiraz, Iran.
Introduction
pirituality is a vital principle of human
existence and has been accepted by
many religions, cultures, and traditions
around the world. Spirituality is the essence of
humans' nature which denotes the meaning of
life and sense of connection to a transcendent
phenomena (e.g., the universe or God). This
connection may or may not be part of any
religion (1). Spiritual well-being is a sense of
satisfaction that comes from peoples' inner-self
and is directly associated with their quality of
life (2). According to the related literature,
spiritual well-being refers to having a sense of
acceptance, positive feeling, adherence to
moral codes, and a sense of mutual connection
with a sacred and supreme power. Spiritual
well-being is achieved through a dynamic and
harmonious process of cognitive, emotional,
action-related, and personal improvements.
Spiritual cognition, spiritual emotions, spiritual
actions, and spiritual achievements can also be
mentioned as the main components of spiritual
well-being (3).
Tourism as a dynamic and systematic activity
provides the tourists with opportunities to
evolve and renovate what they desire (4).
According to the World Tourism Organization,
one of the goals that can motivate tourists to
travel is to travel to restore health (5).
According to Norman (2012), spiritual tourism
can be divided into five categories that can
provide such experiences: healing,
S
Abstract
Background and Objectives: Traveling for health is one of the goals that can drive people to travel. Nowadays, pilgrimage plays
a significant role in the therapy and spiritual well-being of people. Therefore, the present study aimed to study that how spiritual
well-being is achieved through going on pilgrimage to holy places and how it affects all dimensions of one's life.
Methods: The current qualitative research was conducted using the ethnographic method to fulfill the purpose of the study. Data
were collected by conducting semi-structured in-depth interviews with 30 female tourists. Purposive sampling was performed by
referring to the pilgrimage sites in Shiraz, Iran. The collected data were analyzed based on the content analysis technique.
Results: The results of the present study indicated that pilgrimage constitutes eight organizing themes: discovery of the
existential meaning, sense of place, spiritual action, emotionalism, connection, miraculous treatment, renewal and remembrance,
and purposefulness. In the end, the global theme was seeking treatment through spiritual means.
Conclusion: Understanding the relationship between therapy, spirituality, and spiritual well-being and sacred places can promote
a different insight, helping us to provide solutions for the treatment and improvement of believers and even non-believers. Believers
are in search of meaning and seek spiritual well-being. By visiting holy places, they strengthen their hope, faith, and sense of
purposefulness, as well as improve their psychological and mental health. Accordingly, nowadays, most people seek spiritual
therapy to restore their spiritual well-being.
Keywords: Therapy, Spirituality, Spiritual well-being, Female Tourists, Holy Places, Ethnography.
Original Article Health, Spirituality and Medical Ethics. 2020;7(1):48-59
Please Cite This Article As: Moaven Z. Therapy, Spirituality, and Spiritual Well-being: A Qualitative study of
Holy Places Tourists. Health Spiritual Med Ethics. 2020;7(1):48-59.
This is an open-access article distributed under the
terms of the Creative Commons Attribution-Non
Commercial 4.0 International License
*Correspondence: Should be addressed to Ms. Zahra
Moaven. Email: z.moaven@shirazu.ac.ir
49 Health, Spirituality and Medical Ethics - Vol.7, No.1, Mar 2020
experimentation, search for personal discovery and knowledge or solitude, and collectivism.
Currently, health has a higher priority in daily life and wellness activities (6).
From an ethnographic point of view, the only appropriate way to study social and cultural
phenomena is to study them during the process. Ethnography is a qualitative
methodology through which the researcher describes the values, behaviors, beliefs, and
common language of a cultural group (7).
Since pilgrimage plays a significant role in treatment, healing, and spiritual well-being,
tourists attempting to improve their lives choose pilgrimage. The current study with the
help of ethnography examined the sacred places and their role in the therapy and
spiritual well-being of the Tourists.
Studies in Iran and other countries focused on the impact of spirituality on lifestyle and
quality of life, and some of these studies have explored the concept of spirituality. In
explaining the concept of spirituality in tourism using content analysis, Shafi'a (4)
argues that the increasing curiosity of modern tourists to grasp new concepts has altered the
previous solely earthly view into a fresher point of view of the spiritual tourism. In a
study entitled "healthy society depends on spirituality (with emphasis on the role of
pilgrimage)", Vasokalaie (8) suggests that praying is one of the fundamental and
important ways with which human beings can prevent physical, mental, and social illnesses.
Warfid et al. (9) studied the therapeutic value of pilgrimage travels and found that pilgrimage
has social, psychological, and spiritual therapeutic values. Pargament and Maton (10)
found that performing religious duties, such as pilgrimage reduces anger and anxiety. Neis
and Vintrab (11) concluded that people participating in religious rituals (e.g.,
pilgrimage and worship) had decreased mental disorders (12). In a study conducted by Morris
(13) it was indicated that patients' symptoms significantly decreased after the pilgrimage
and the reduction continued for at least 10 months after returning from pilgrimage. In
another study, Prim (14) examined places of spiritual importance and studied their
association with therapy. In addition, MacGettigan (15) in the study entitled
“walking labyrinths: spirituality, religion, and wellness tourism” showed that the growing
number of pilgrims is the response to the need for spirituality to confront materialism and
chaos of our time.
Considering the related literature and to the best of the researchers' knowledge, As far as
we have examined, no study has been conducted regarding therapy, spirituality, and
spiritual well-being of pilgrims of the holy places. Accordingly, the present study aimed
to examine that how spiritual well-being is achieved through going on pilgrimage to holy
places and how it affects all aspects of a person's life.
Methods
Research methodology is the most important part of any research (16). The present research
was performed using a qualitative method and an ethnological approach. There are different
forms of ethnography and the most common of these is realist ethnography and critical
ethnography (17).
According to the purpose of the current study, realist ethnography was selected. Since
the present research was determined to conduct an in-depth study of the subject under
discussion to understand why women visit
these holy places and are attracted to them.
The term ethnography is rooted in cultural
anthropology. Ethno means people or ethnicity and graph means describing one thing. Clifford
Geertz, an American anthropologist, believes that thorough and accurate description is an
important part of ethnography. It means a rich description of specific cases (as opposed to
summarizing, standardizing, generalizing or working with variables).
An in-depth description of a three-minute event can fill multiple pages and such a
description can express what happened, reveal the latency of the event, and provide a multi-
faceted interpretation (18).
Health, Spirituality and Medical Ethics - Vol.7, No.1, Mar 2020 50
the behaviors and events that take place in that
place, and using the observations of others
(e.g., peoples’ accounts of the sacred place)
(19).
Therefore, for the study of sacred places in
the present research, places that were already
ignored in such studies were selected. Such a
method can reveal the depth of tourists’
attitudes toward these sites and determine the
reasons for their attraction to these places. To
achieve this goal, the most visited holy places
of Shiraz, Iran, were selected.
According to the purpose of the present
study, the participants were selected based on a
purposive sampling of the tourists of the
following holy shrines of Hazrat Ahmad bin
Musa (PBUH), Sayyed Alaeddin Hussein
(PBUH). Statistically, these shrines had the
most tourists, yearly. Therefore, regarding the
research ethics, tourists who were willing to
participate based on the required
characteristics such as age, gender, and
pilgrimage travel experience were entered into
the study.
According to the available statistics, since
women engage in religious pilgrimage rather
than men and they constitute the main pillars
of society, they were selected as the sample
population. In addition, women who had
experience of pilgrimage and were willing to
express their feelings were selected. In this
regard, age diversity was also taken into
consideration and it was attempted to select
women of different ages (e.g., young, middle-
aged, and old) and in different decades of life
(from forty to seventy). In-depth interviews
and participant observation were carried out to
collect information. Furthermore, thematic
analysis and content analysis were used to
analyze the collected data.
Participant observation is one of the most
common ways for collecting qualitative data,
as well as it is one of the most difficult
methods that requires a researcher to
participate in the culture, context, and
environment of the subject that s/he wishes to
observe. As a result, the researcher of the
current research has been present in the
selected sacred places a year prior to the time
of conducting the study and has examined the
field and its culture. Interviews start with
general questions of why do you go on a
pilgrimage? Why did you choose this place?
What do you expect of this place? Then
continues with exploratory questions to obtain
more in-depth information.
Interviews were recorded after obtaining
permission from the participants, then
transcribed and themed. The researcher who
had a prior qualitative research background
and acquired the necessary skills and training
on how to conduct qualitative research by
maintaining the dignity of the holy place and
the dress code that is customary for these sites
were present during all the research stages and
interviewed all the participants.
In order to obtain accurate data, validity,
reliability, and transferability of the collected
information were verified (20). To ensure the
validity of the findings, the researcher took
sufficient time to collect the data and
maintained a long-term involvement in the
process by visiting the sacred places
repeatedly. In addition, to strengthen the
validity of the extracted content, a number of
coded interviews were returned to the
participants to allow for member reviews. The
reliability of the findings was assured through
professors' reviews. (i.e., after the interviews,
the professors who were not involved in the
data collection process, listened to the
interviews, compared them with the written
text, and applied the necessary changes.
In order to verify, the researcher tried to not
enter his/her assumptions in the data collection
and analysis processes. The transferability of
the data was assured through revision by five
women who were not involved in the research
process. The interviews lasted 50-90 min and
sampling continued until saturation of the data.
Concurrent with the data collection process,
data analysis was performed. At first, each
interview transcript was read several times and
the initial codes were extracted. Thereafter, the
participants' phrases and keywords were
identified and then the initial codes were
revised into analytical codes. Then, after
modifications, the codes were organized into
basic theme, organic theme, and global theme.
In the content analysis phase, the researcherTherapy, Spirituality, and Spiritual Well-being
51 Health, Spirituality and Medical Ethics - Vol.7, No.1, Mar 2020
extracted a series of fundamental concepts and
patterns and then categorized the obtained
data. Finally, the global theme of seeking
treatment through spiritual means was
extracted.
Prior to conducting the interview, the role of
the researcher, subject, and purpose of the
research were explained to the participants.
The interviews were recorded after obtaining
the permission of the subjects, and in any part
of the interview, if the participants were
unwilling to let their voices to be recorded,
interviews were paused and the researcher took
notes.
Result
A total of 30 female tourists with the age
range of 18-55 years participated in the present
study. The subjects’ educational background
varied from diploma to PhD. The findings of
the current study showed that the concept of
pilgrimage was composed of eight themes and
the global theme was seeking treatment
through spiritual means. Table 1 demonstrates
an overview of the global theme (seeking
healing through spiritual means), organizing
themes (discovering existential meaning, sense
of place, spiritual action, emotionalism,
connection, miraculous treatment, renewal and
remembrance, and purposefulness). In
addition, it presents the main themes of the
present research.
Based on the findings of the present research
and the thematic and multi-step analysis that
followed the multiple and repeated coding of
the research findings, the global theme of the
pilgrimage was “to seek treatment through
spiritual means”. Therefore, pilgrimage as a
phenomenon that heals and treats the tourists is
analyzed and interpreted. The themes that
constitute this organic theme are “discovering
existential meaning, sense of place, spiritual
action, emotionalism, connection, expectation,
miraculous treatment, renewal and
remembrance, and purposefulness”.
Based on the findings of the study, we found
that sacred places provide ways to improve
and cure tourists at some levels. According to
the participants’ accounts, pilgrimage and
visiting the sacred places push tourists to
discover their existential meaning, through
reflection in a spiritual place and the spiritual
actions that they perform. Holy places help
them to reach an inner satisfaction and through
the connections and expectations of the sacred
place, they could reinforce their beliefs and
fulfill their wishes. In addition, the holy places
help them to restore their psychological,
mental, and even physical health at any stage
of the travel, including before the travel,
during, and at the sacred place.
Table 1. global Theme of Seeking treatment through spiritual
means
Organic
Themes Basic themes Examples
Discovering
existential
meaning
Self-observation
Self-reflection
Discovery of meaning,
internal and external
transformation,
contemplation, freedom
from material structures
Sense of
place
Spiritual
atmosphere
Magnetic force
Realm of silence
Presence of Imamzadeh,
architecture, fragrant
atmosphere, solitude,
spiritual energy
Spiritual
action
Ritualism
transaction
Acceptance
vow, sadaqah, charity,
endowment, waqf
Emotionalism
Relief
Emotional energy
Excitement
Peacefulness, spiritual
need, a surge of
emotions, impressiveness
Connection
Spiritual
connection
Earthly connection
Good mood, connection,
interaction with other
pilgrims
Miraculous
treatment
Healing
Karamat
Miracle
Cure, freedom, treatment,
peacefulness, solved
problem
Renewal and
remembrance
Religious beliefs
vow
Faith in God, become
innocent, servitude
Purposefulness
Inner satisfaction
Excellence
Rebirth
Personal growth,
meditation, promotion,
personal growth self
awareness,
Discovering the existential meaning
Regarding the discovery of the existential
meaning, extracted themes from the
participants’ opinions included self-
observation and self-reflection. Search for
meaning drives mankind toward different
places (e.g., known and unknown, far or near,
man-made and natural) (21). Participants
stated that visiting these sacred sites provided
an opportunity to contemplate their own
existence and to make some evaluations. The
participants’ search for privacy was in line
with this reflection and contemplation.
Self-observationMoaven Z
Health, Spirituality and Medical Ethics - Vol.7, No.1, Mar 2020 52
In the ethnographic experience of these
places, some tourists engaged in dialogues or
laughter and empathy, and some with patience
and confidence examined their actions and
behaviors, sometimes even they did not feel
the passage of time and were trapped in their
spiritual realm of their inner world.
Marzieh, 30-year-old:
"I always try to find a place of solitude, to
look for a cozy place, then I start to speak with
God, I talk about my actions, behaviors, and
all the things I've done, I tell everything"
Self-reflection
There are different categorizations of the
holy places’ tourists and the common
characteristic among them is that they believe
visiting holy places is an opportunity for
contemplation. The value of this reflection and
thinking is not less than worshiping and
performing the rituals. It is this reflection and
thought that helps the tourists to lead a better
life.
Mahsa, 25-year-old:
"In my opinion, these places are not just for
worship and pray, I come here to think, to see
what I’ve done and what should I do, what I
can do to change, to get better; so, here I am
trying to feel free, I'm not looking for
boundaries, as if here gives you an opportunity
to just sit down and think”
Sense of place
Search for spirituality drives people to
different places. It is the influences that these
places have on people that show the power of
these holy and sacred sites. Holy places
possess an intrinsic property of attracting the
seekers and quenching their thirst for the truth.
Pilgrimage travels change a person and
reinforce their adherence to performing good
deeds. The combination of reflection, contact,
prosperity, and well-being give people the
required energy to understand and affirm
higher human goals. After understanding their
place in the system of existence, these travelers
find themselves compelled to question
everything and open-mindedly devote
themselves to harmonizing with the society
and environment and to pay attention to the
welfare of all three components of (self,
society, and environment). Spiritual journeys
help one to be free his heart and soul and
understand the meaning of life. Spiritual
pilgrimage enables individuals to see
themselves and others as one and to join a
network of homogenous communities (21).
Spiritual atmosphere
Light, color, mirroring, fragrant atmosphere,
and architecture of the holy places and the
energies that resulted from the presence of
tourists in these places create a special spiritual
atmosphere and it affects the tourists’
behaviors. They felt affected from the moment
they stepped into the place and their zeal for
pilgrimage doubled healing all of their
difficulties. A tourist’s account of this
experience in the form of a semi-structured
interview is as follows:
One-hour interview with 45-year-old Zainab:
“Spirituality and architecture of these places
are very influential, they completely change
your mood, when you enter into these places,
you feel relaxed and it is like a cool breeze
across your face”.
Magnetic force
Elements that made the sacred places to look
impressive along with the provision of a
relaxed and hospitable environment for
reflection and thinking emitted positive
energies. Tourists referred to these energies as
magnetic forces, energies that pulled them
toward these holy places and encouraged them
to perform the religious rituals with special
enthusiasm.
Throughout the conversation, Taherah
enthusiastically referred to the design,
architecture, and coloring of the shrine.
Elements that make the tourists feel that they
entered into a totally special and different
environment. Tahereh’s narration is as follows:
Tahereh, 22-year-old:
"All the elements in this place are like
magnets, they all attract you, from glassworks
to the zarih".
Realm of silence
The participants believed that visiting a
sacred place should be accompanied by special
practices and rituals, including the expression
of humility and servitude in the presence of the
Almighty and keeping silent before him.
Consequently, some people believed thatTherapy, Spirituality, and Spiritual Well-being
53 Health, Spirituality and Medical Ethics - Vol.7, No.1, Mar 2020
visitors should not behave in any way that
disturbs the peace of these sacred places or
prevents the rituals from being performed
correctly.
Fatima's experience of being in the holy
place referred to escaping from the hustle and
bustle of the outside and searching for a place
that comforts her.
Fatima, 26-year-old:
"I love the ceremonies in the holy shrine, but
all of them are performed in groups. I'd like to
be where I can sit back in silence and think.
Sometimes the whispers of the other visitors
disturb me, but I want to be left alone".
Spiritual action
Spirituality was always present in each action
or behavior in sacred places. Given the
intentions and motivations of the tourists for
traveling to sacred places, they performed
practices that had influence both on themselves
and others. Therefore, these practices are
considered to be invaluable.
Ritualism
Religion consists of two basic elements of
beliefs and deeds. Beliefs are ideas and deeds
are ways of social action. Some of the
religious practices (e.g., rituals) are an integral
and important part of any religion which can
be the source of many developments in social
life (22). The ritual dimension "encompasses
the specific religious practices that followers
of any religion are expected to perform" (23).
Tourists believed that they were bound to
perform religious rituals that began before the
pilgrimage and continued them until after the
pilgrimage. They believed that they should
perform certain rituals before traveling to a
holy place, while at the place, and after the
pilgrimage. The degree of their adherence to
the rituals is based on their passion for the holy
place and Imamzadeh.
Performing these rituals, in addition to
assuring them that they have performed their
religious deeds as God ordered, also provide
them with a degree of reassurance:
Haniyeh, 49-year-old:
"From the moment that I step out of my
home by the time that I get to the shrine, I
pray. I feel like if I don't do this, my
pilgrimage will not be accepted, I will not feel
good otherwise”.
Transaction
Some tourists bargain for the fulfillment of
their wishes and sometimes it is very important
to them to evaluate how important their wish
is, to give more assets. This exchange is made
in forms of gift, sadaqah, charity, endowment
(i.e., waqf).
Mahin, 54-year-old:
"Last time that I came here I made a vow that
if I heal, I will donate the carpet that I’ve
weaved. Alhamdulillah, I've got what I
wanted. So, this time I brought the carpet, I'm
very happy".
Acceptance
Tourists believe that unlike other places,
there are special requirements for getting
invited into sacred places. Those who are
invited should ask for permission to be
allowed to enter into the sacred place. For
some tourists, it is extremely important that
they feel that they have received permission to
enter into the holy place and they understand
whether they have the permission or not
through changing their moods or feelings.
The feeling of wanting and being invited
created special joy in the visitors’ hearts.
Shabnam was one of those visitors who spoke
enthusiastically in this regard:
Shabnam, 39-year-old:
“You should be invited to such places, you
can’t go on your own. Then after you are
invited, there are some rules that you have to
obey, you should ask for permission and then
they may accept you. In this way both you and
they wanted you to be here”.
Emotionalism
Emotion is an integral part of religion, as
religiosity always encompasses emotions.
Emotion is both personal and relational,
private and social, living and cultural.
Religious emotion is built not only through
social communication but also through beyond
social communication as well (e.g., sacred
affairs, sacred industries, and sacred texts)
(24). Many tourists experience different
emotions when they are in a sacred place and
they show these emotions in various ways.
These feelings are promising since they areMoaven Z
Health, Spirituality and Medical Ethics - Vol.7, No.1, Mar 2020 54
signs that tourists will benefit from visiting
these holy places.
Relief
Being present in sacred places and
experiencing different kinds of feelings has
brought some transient or permanent relief to
the visitors. They were so relieved that even
some of them stated that they have forgotten
what reason brought them to these holy places
in the first place. This peacefulness transferred
them from a tumultuous outer world to a safe
haven.
Fattaneh, 36-year-old:
"I prefer the shrine of the Imams and
Imamzadehs, their holiness gives me peace, a
while ago I was disturbed but now I feel so
relaxed that I do not know why I came here in
the first place."
Emotional energy
Faith and belief as sources of emotional
energy guide the visitors to perform their
religious duties and interact with other tourists
and help them to express themselves in
different ways by showing their emotions.
Sakineh, 19-year-old:
"In this place, I feel more and more that I
have faith in the power of God. I believe that I
can rely on him, this makes me feel his
presence; therefore, I’m sure that he hears my
prayers, solves my problems, and helps me to
feel good”.
Excitement
Pilgrimage is often accompanied by specific
emotions and excitements that affect visitors.
Some participants mentioned specific emotions
that had only been experienced in the sacred
places and they did not experience these
emotions before, and others spoke of their own
emotional experiences.
Marjan, 21-year-old:
“Ever since I arrived here I start crying from
happiness, I got goose bumps, the moment I
saw the Zarih I could not swallow back my
tears anymore and burst into tears, I just
wanted to cry out loud"
Connection
Pilgrimage provides a platform for people to
spiritually connect to each other. It makes
them feel spirituality and start some inner
transformations in themselves. Visitors regard
this connection as a starting point for the
transformation. In their view, for achieving an
effective connection, some conditions are
required and sometimes these conditions are
related to the intentions of starting pilgrimage
travel.
Spiritual connection
The connection of religious tourists in the
sacred place is sometimes purely
psychological and spiritual and this connection
is achieved through the connection between
the heart of the pilgrims and God and
Imamzadeh. Their effects are manifested
through the expression of emotions and
excitements.
Safura, 19-year-old:
"I try to get in touch with the God or
Imamzadeh anytime possible, I feel this
connection when my heart is broken,
especially when I ask for permission to enter
into the holy places and I say that if you don't
want me to come I will return to where I came
from and by saying this I burst into tears”.
Earthly connection
A significant part of the connections in the
sacred places is through bonding and
interaction with other visitors which plays a
significant role in the improvement of the
mental state and healing of visitors, thereby
transmitting one's religious and social
experiences to one another. It has an important
role in changing people's moods and lifestyles.
Mahin, 29-year-old:
"In this place, not only can you talk to your
God, there are times when you try to interact
with the person who sat next to you, you can
even befriend her".
Miraculous treatment
Tourists have turned interest to pilgrimage
therapy. They believe that pilgrimage provides
an opportunity for different people with
different opinions to assemble in a sacred
place and to develop a spiritual and social
connection. The result of this assembling and
connection is the achievement of the
psychological relaxation that has its effects on
various aspects of visitors' life.
Healing
Many visitors believe in healing and seek
healing from sacred places. They visit theseTherapy, Spirituality, and Spiritual Well-being
55 Health, Spirituality and Medical Ethics - Vol.7, No.1, Mar 2020
places to pray for the health of themselves,
their friends, and relatives and to ask the
Imamzadeh to mediate between them and God.
Soraya, 52-year-old:
"I came here since I want my daughter to be
healed, I am sure my presence here on this
blessed month was not without reason, I am
sure that I see a miracle"
Karamat
Some visitors believed in the Imam's
karamats and they aspired to be bestowed by
these karamats.
Safia, 47-year-old:
"God have mercy on me, solve my problems,
I hope he forgives me, I do not want to return
empty-handed"
Miracle
And some others believed in miracles
because they had no other choice. On one
hand, they were disappointed with others and
on the other hand, they considered their desire
so enormous that thought only an ultimate
power capable of granting miracles could
fulfill their wishes.
Zinat, 35-year-old:
"All doctors said that they ran out of options,
they said they can't do much, but I believe in
miracles, today is the fifth day that my
husband is in a coma, I have no one except
him. The moment doctors said that they can't
help anymore I bought a ticket to come here
and to be here at this Friday night which is
Kamil prayer night, I do believe in his
miracles".
Renewal and remembrance
People who visit the sacred places are
looking forward to renewing their experiences
and religious practices. Since they want to
break free from routineness and lethargy of
modern life, they look for a source to gain
spiritual energy. Consequently, they visit the
holy places.
Religious beliefs
Religious beliefs of the visitors constitute an
integral part of the pilgrimage, which remind
them by their presence in the sacred places and
they show themselves actively and
dynamically in prayers and religious duties.
Fatima, 20-year-old:
"Pilgrimage is a reminder of the faith, the
things you have learned, things may have now
faded, you remember these kinds of things in
these places, especially when you pray or read
the biography of Imamzadeh".
Vow
Visitors mentioned a mutual renewal of
covenants with the Almighty God. They
believed that this covenant was attributed to
the Imams and Imamzadehs.
Zakieh, 53-year-old:
"I vowed that if the Imamzadeh interceded
and God hears my prayers, I would come here
once a year, but not just come once or twice,
try to keep it going".
Purposefulness
Visitors stated that they started the journey
with pilgrimage purposes and sought to attain
internal and ethical development by acquiring
epistemological knowledge; therefore,
achieving inner excellence and satisfaction.
Excellence
The visitors acknowledged that their goal of
the pilgrimage was to reach excellence, which
was often accomplished by growing and
changing themselves.
Hamide, 48-year-old:
"I hoped that pilgrimage would make me
change for the better, both mentally and
socially. I've learned so much from my
travels".
Inner satisfaction
Satisfaction resulting from pilgrimage can
bring inner peace to visitors and it is very
effective in improving their mental health.
Razieh, 24-year-old:
"When I take a break from daily life, I sense
that I have a special feeling as if I have been
comforted from the inside and I've got
whatever I wanted"
Rebirth
Pilgrimage creates an opportunity for tourists
to reborn. After the pilgrimage ends, they feel
clean and new in the body and soul. They
believe that since they feel like they were born
once again; therefore, when they back to their
daily lives and they will apply this sense of
freshness into their daily routine and personal
lives.
Marzieh, 55-year-old:Moaven Z
Health, Spirituality and Medical Ethics - Vol.7, No.1, Mar 2020 56
"Today that I'm coming back from the holy
shrine, I'm relieved, I feel like I was just born,
I'm feeling carefree, with no sadness, I feel so
good that I can't express".
Discussion
Tourists are mostly interested in visiting
sacred sites and having unique experiences.
There are numerous incentives that encourage
people to choose sacred places as a traveling
destination. Apart from happiness, other
motivations are including, healing and
wellness. Health is one of the top priorities in
daily life and the sacred places are where
recovery is expected to be achieved through
social, emotional, and spiritual interactions
until the person reaches his/her desires.
Given the importance of sacred places and
peoples’ expectations from them, the purpose
of the present study using ethnography and
thematic analysis technique was to answer the
following question of how spiritual therapy
and spiritual well-being is achieved through
visiting the sacred places.
The recording of women's narratives showed
that sacred places were important sites that
provided a good platform for women to reach
self-knowledge, interact socially, act
emotionally, and transform internally.
In addition, the participants indicated that
these places had special features that attracted
them, such as unique design, security,
peacefulness, and collaborative action.
The researcher’s observations demonstrated
that these days, pilgrimage travels play a key
role in the treatment and healing process, and
sacred places are of prime importance
regarding this matter.
In the current study, women stated that they
seek to discover their existential meaning
through contemplation and self-observation in
the sacred places, particularly the sense of
being in a spiritual place was important to
them.
Pilgrimage of a sacred place is like a journey
in search of truth, a journey to a place that is a
reflection of divine power and providence. In
other words, the search for truth and
enlightenment entwined with the divine and
sacred concepts inspires people to visit these
places as they go beyond ordinary daily life. In
such places, one does not consider the basis of
the relationships as materialistic; however,
"metaphysical and supernatural searches
throughout history" draw people to places
where they feel free from the mundanities of
the earthly life (28) with the aim of getting out
of confusion. In fact, the sacred places provide
an opportunity for tourists to contemplate,
away from the chaos of everyday life and to
gain insights and discover their existential
meaning. Therefore, to become remote from
the sense of absurdity that sometimes engulfs
them.
Holy and sacred places evoke a unique
feeling encompassed by different experiences.
Internal and external needs bring people to
these places and a set of elements that exist in
these places have an influence on tourists and
create an aspiration in them to fulfill their
desires and expectations. Ultimately, these
spiritual atmospheres and received spiritual
energies from these realms of reflection
provide tourists a sense of well-being or inner-
exterior-peace.
The created connections are spiritual and
materialistic connections that on the one hand,
affect the spirit of the tourists and on the other,
connect them with others, which they are
regarded as a source of comfort. Pilgrims build
a closer relationship with God by going on
pilgrimage and visiting sacred places gives
them a sense of psychological security. A
sense of closeness to God leads to a greater
satisfaction with life and they promise to stay
away from deviations (25).
The results of the current study indicated that
part of the women's intention for entering into
the religious sites was to perform spiritual
activities that some of which play a major role
in filling the women's emotional and spiritual
void. Turki showed that a place of worship is
where people become detached from the
mortal and materialistic worlds, say prayers,
and reach spiritual comfort (25). The
abovementioned findings were in line with the
results of a study conducted by Vasokalaie
(26).
Furthermore, visiting sacred places makes
tourists spiritually relaxed. The resultantTherapy, Spirituality, and Spiritual Well-being
57 Health, Spirituality and Medical Ethics - Vol.7, No.1, Mar 2020
spiritual change of the visitors is demonstrated
through different emotions. It renews the
feeling of vitality and happiness in them and
shows its effects in other parts of the journey
and the visitors' lives and assures them that the
purpose of the journey has been fulfilled.
Hope in mankind is what makes his efforts
meaningful and gives strength to him.
According to the surveys, every living creature
performs its daily activities with hope (27).
Since treatment sometimes is received
miraculously from the sacred places, the
participants of the present study stated that
they sought it through pilgrimage. In fact,
sacred places become places for demanding
the fulfillment of their needs. Although these
desires and ways of fulfilling them may
require extraordinary powers (e.g., miracles),
the pilgrims' hope, faith, and belief make them
attainable. They believe that everything is in
God's hand.
The results of the present study indicated that
from the beginning of the pilgrimage, tourists
expect that every step that they have taken in
order to visit the Imamzadeh will help them to
be forgiven after death. Therefore, they keep
their vows and renew them by continuously
visiting holy places.
As it was shown in the study carried out by
Warfield, the pilgrimage had a significant
impact on the visitors' views of their lives,
relationships, identities, and their future plans.
From the perspective of mental health service
providers, access to knowledge about previous
(or sacred) travel is important (9). The current
findings also confirmed that the pilgrimage
begins with a purposeful journey and visitors
plan for their journey from the beginning.
Female visitors stated that spiritual excellence
mattered the most to them. This spiritual
excellence is achieved through faith,
strengthened communication with the
Almighty, and remembrance and renewal of
beliefs.
The categories of the discovery of existential
meaning, sense of place, spiritual action,
emotionalism, connection, expectation,
miraculous treatment, renewal and
remembrance, and purposefulness form a
global theme of seeking treatment through
spiritual means.
Traveling to sacred places for the sake of
therapy reflects a desire to be present and have
access to places beyond the confined spaces of
daily life. Places that enable individuals to
focus on their physical, emotional, and
spiritual pursuits and expect them to become
fulfilled. Achievement through spirituality is
the way that they seek their healing. The
categories of the discovery of existential
meaning, sense of place, spiritual action,
emotionalism, connection, expectation,
miraculous treatment, renewal and
remembrance, and purposefulness are among
the means that pave the way for achieving this
purpose.
Conclusion
Based on the findings of the current study,
healing and spiritual well-being are achieved
through visiting sacred places. Since these
holy sites provide an appropriate context for
interactions, actions, ritual and worship, and
emotional evacuation. Some of these practices
are in the form of collective cultural programs
and some individually. In the meantime, the
tourists' expectations of being in such cultural
and spiritual setting and the impact that the
atmosphere has on them should be considered.
This expectation is that they believe cure and
improvement will be achieved by visiting these
places.
The results of the present study indicated that
sacred places by providing a secure
environment drag the tourists out of the chaos
of the outside world and help them to have a
deep transition and begin a profound
transformation. In the meantime, the impact of
this atmosphere entwined with cultural and
spiritual programs is very influential to let the
tourists to emotionally evacuate themselves.
Emotional states that are created under the
influence of the sacred places are very
important in establishing the earthly and
spiritual connections, because the stronger the
spiritual connection is, the more they fulfill
their purpose of pilgrimage. As the purpose of
visiting the sacred places is to heal throughMoaven Z
Health, Spirituality and Medical Ethics - Vol.7, No.1, Mar 2020 58
receiving karamat and transformation of their
inner feelings.
Presence in the sacred sites is accompanied
by the renewal and remembrance of religious
beliefs. It is a renewed covenant with the
almighty and a way of avoiding laziness.
Ultimately, at the end of the pilgrimage,
reaching their goal that they have started the
journey for, is the only thing that is important
to the tourists. This goal is a sense of inner
satisfaction. This satisfaction is not only
effective in improving the psychological well-
being of the tourists but also it is regarded as
an opportunity to feel reborn. Now, s/he is
born once again physically and mentally and
returns to his/her personal life with a different
sense of purpose.
Accordingly, it can be stated that spirituality
in tourism and pilgrimage is of great
importance today and there have been efforts
to improve and ameliorate different aspects of
life. Therefore, resulting in attraction of
attention toward pilgrimage tourism. Today
more than ever, the search for healing through
spiritual means attracts the seekers of spiritual
well-being to itself due to the inability of the
earthly means to provide the most essential of
human needs, namely peace.
Understanding the relationship of healing,
spirituality, and spiritual well-being with the
sacred places can promote a very different
perspective that helps us to provide solutions,
to help, and treat believers and even non-
believers. Because believers, those who are in
search of meaning and spiritual well-being can
accomplish their wishes through the
reinforcement of hope, faith, purpose, and
pilgrimage travels, as well as they can achieve
spiritual and psychological healing. Moreover,
the non-believers can be comforted and
soothed through contemplation and emotional
evacuation. Therefore, most people these days
search for healing through spiritual means to
ensure their spiritual well-being.
Conflict of interest
The author declared no conflicts of interest
regarding the current research project.
Acknowledgements
The authors' sincere appreciations go to those
who assisted us in conducting the current
research, especially to the authorities of holy
places in Shiraz who issued the approval to
carry out the present project. Furthermore, our
sincere gratitude goes to the tourists
participating in this research.
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Full-Text: (478 Views)
Therapy, Spirituality, and Spiritual Well-being: A Qualitative Study of Holy
Places Tourists
Received 30 May 2019; Accepted 08 Dec 2019
http://dx.doi.org/10.29252/jhsme.7.1.48
Zahra Moaven1*
1 School of Economics, Management and Social Sciences, Shiraz University, Shiraz, Iran.
Introduction
pirituality is a vital principle of human
existence and has been accepted by
many religions, cultures, and traditions
around the world. Spirituality is the essence of
humans' nature which denotes the meaning of
life and sense of connection to a transcendent
phenomena (e.g., the universe or God). This
connection may or may not be part of any
religion (1). Spiritual well-being is a sense of
satisfaction that comes from peoples' inner-self
and is directly associated with their quality of
life (2). According to the related literature,
spiritual well-being refers to having a sense of
acceptance, positive feeling, adherence to
moral codes, and a sense of mutual connection
with a sacred and supreme power. Spiritual
well-being is achieved through a dynamic and
harmonious process of cognitive, emotional,
action-related, and personal improvements.
Spiritual cognition, spiritual emotions, spiritual
actions, and spiritual achievements can also be
mentioned as the main components of spiritual
well-being (3).
Tourism as a dynamic and systematic activity
provides the tourists with opportunities to
evolve and renovate what they desire (4).
According to the World Tourism Organization,
one of the goals that can motivate tourists to
travel is to travel to restore health (5).
According to Norman (2012), spiritual tourism
can be divided into five categories that can
provide such experiences: healing,
S
Abstract
Background and Objectives: Traveling for health is one of the goals that can drive people to travel. Nowadays, pilgrimage plays
a significant role in the therapy and spiritual well-being of people. Therefore, the present study aimed to study that how spiritual
well-being is achieved through going on pilgrimage to holy places and how it affects all dimensions of one's life.
Methods: The current qualitative research was conducted using the ethnographic method to fulfill the purpose of the study. Data
were collected by conducting semi-structured in-depth interviews with 30 female tourists. Purposive sampling was performed by
referring to the pilgrimage sites in Shiraz, Iran. The collected data were analyzed based on the content analysis technique.
Results: The results of the present study indicated that pilgrimage constitutes eight organizing themes: discovery of the
existential meaning, sense of place, spiritual action, emotionalism, connection, miraculous treatment, renewal and remembrance,
and purposefulness. In the end, the global theme was seeking treatment through spiritual means.
Conclusion: Understanding the relationship between therapy, spirituality, and spiritual well-being and sacred places can promote
a different insight, helping us to provide solutions for the treatment and improvement of believers and even non-believers. Believers
are in search of meaning and seek spiritual well-being. By visiting holy places, they strengthen their hope, faith, and sense of
purposefulness, as well as improve their psychological and mental health. Accordingly, nowadays, most people seek spiritual
therapy to restore their spiritual well-being.
Keywords: Therapy, Spirituality, Spiritual well-being, Female Tourists, Holy Places, Ethnography.
Original Article Health, Spirituality and Medical Ethics. 2020;7(1):48-59
Please Cite This Article As: Moaven Z. Therapy, Spirituality, and Spiritual Well-being: A Qualitative study of
Holy Places Tourists. Health Spiritual Med Ethics. 2020;7(1):48-59.
This is an open-access article distributed under the
terms of the Creative Commons Attribution-Non
Commercial 4.0 International License
*Correspondence: Should be addressed to Ms. Zahra
Moaven. Email: z.moaven@shirazu.ac.ir
Therapy, Spirituality, and Spiritual Well-being
49 Health, Spirituality and Medical Ethics - Vol.7, No.1, Mar 2020
experimentation, search for personal discovery and knowledge or solitude, and collectivism.
Currently, health has a higher priority in daily life and wellness activities (6).
From an ethnographic point of view, the only appropriate way to study social and cultural
phenomena is to study them during the process. Ethnography is a qualitative
methodology through which the researcher describes the values, behaviors, beliefs, and
common language of a cultural group (7).
Since pilgrimage plays a significant role in treatment, healing, and spiritual well-being,
tourists attempting to improve their lives choose pilgrimage. The current study with the
help of ethnography examined the sacred places and their role in the therapy and
spiritual well-being of the Tourists.
Studies in Iran and other countries focused on the impact of spirituality on lifestyle and
quality of life, and some of these studies have explored the concept of spirituality. In
explaining the concept of spirituality in tourism using content analysis, Shafi'a (4)
argues that the increasing curiosity of modern tourists to grasp new concepts has altered the
previous solely earthly view into a fresher point of view of the spiritual tourism. In a
study entitled "healthy society depends on spirituality (with emphasis on the role of
pilgrimage)", Vasokalaie (8) suggests that praying is one of the fundamental and
important ways with which human beings can prevent physical, mental, and social illnesses.
Warfid et al. (9) studied the therapeutic value of pilgrimage travels and found that pilgrimage
has social, psychological, and spiritual therapeutic values. Pargament and Maton (10)
found that performing religious duties, such as pilgrimage reduces anger and anxiety. Neis
and Vintrab (11) concluded that people participating in religious rituals (e.g.,
pilgrimage and worship) had decreased mental disorders (12). In a study conducted by Morris
(13) it was indicated that patients' symptoms significantly decreased after the pilgrimage
and the reduction continued for at least 10 months after returning from pilgrimage. In
another study, Prim (14) examined places of spiritual importance and studied their
association with therapy. In addition, MacGettigan (15) in the study entitled
“walking labyrinths: spirituality, religion, and wellness tourism” showed that the growing
number of pilgrims is the response to the need for spirituality to confront materialism and
chaos of our time.
Considering the related literature and to the best of the researchers' knowledge, As far as
we have examined, no study has been conducted regarding therapy, spirituality, and
spiritual well-being of pilgrims of the holy places. Accordingly, the present study aimed
to examine that how spiritual well-being is achieved through going on pilgrimage to holy
places and how it affects all aspects of a person's life.
Methods
Research methodology is the most important part of any research (16). The present research
was performed using a qualitative method and an ethnological approach. There are different
forms of ethnography and the most common of these is realist ethnography and critical
ethnography (17).
According to the purpose of the current study, realist ethnography was selected. Since
the present research was determined to conduct an in-depth study of the subject under
discussion to understand why women visit
these holy places and are attracted to them.
The term ethnography is rooted in cultural
anthropology. Ethno means people or ethnicity and graph means describing one thing. Clifford
Geertz, an American anthropologist, believes that thorough and accurate description is an
important part of ethnography. It means a rich description of specific cases (as opposed to
summarizing, standardizing, generalizing or working with variables).
An in-depth description of a three-minute event can fill multiple pages and such a
description can express what happened, reveal the latency of the event, and provide a multi-
faceted interpretation (18).
Moaven Z
Health, Spirituality and Medical Ethics - Vol.7, No.1, Mar 2020 50
the behaviors and events that take place in that
place, and using the observations of others
(e.g., peoples’ accounts of the sacred place)
(19).
Therefore, for the study of sacred places in
the present research, places that were already
ignored in such studies were selected. Such a
method can reveal the depth of tourists’
attitudes toward these sites and determine the
reasons for their attraction to these places. To
achieve this goal, the most visited holy places
of Shiraz, Iran, were selected.
According to the purpose of the present
study, the participants were selected based on a
purposive sampling of the tourists of the
following holy shrines of Hazrat Ahmad bin
Musa (PBUH), Sayyed Alaeddin Hussein
(PBUH). Statistically, these shrines had the
most tourists, yearly. Therefore, regarding the
research ethics, tourists who were willing to
participate based on the required
characteristics such as age, gender, and
pilgrimage travel experience were entered into
the study.
According to the available statistics, since
women engage in religious pilgrimage rather
than men and they constitute the main pillars
of society, they were selected as the sample
population. In addition, women who had
experience of pilgrimage and were willing to
express their feelings were selected. In this
regard, age diversity was also taken into
consideration and it was attempted to select
women of different ages (e.g., young, middle-
aged, and old) and in different decades of life
(from forty to seventy). In-depth interviews
and participant observation were carried out to
collect information. Furthermore, thematic
analysis and content analysis were used to
analyze the collected data.
Participant observation is one of the most
common ways for collecting qualitative data,
as well as it is one of the most difficult
methods that requires a researcher to
participate in the culture, context, and
environment of the subject that s/he wishes to
observe. As a result, the researcher of the
current research has been present in the
selected sacred places a year prior to the time
of conducting the study and has examined the
field and its culture. Interviews start with
general questions of why do you go on a
pilgrimage? Why did you choose this place?
What do you expect of this place? Then
continues with exploratory questions to obtain
more in-depth information.
Interviews were recorded after obtaining
permission from the participants, then
transcribed and themed. The researcher who
had a prior qualitative research background
and acquired the necessary skills and training
on how to conduct qualitative research by
maintaining the dignity of the holy place and
the dress code that is customary for these sites
were present during all the research stages and
interviewed all the participants.
In order to obtain accurate data, validity,
reliability, and transferability of the collected
information were verified (20). To ensure the
validity of the findings, the researcher took
sufficient time to collect the data and
maintained a long-term involvement in the
process by visiting the sacred places
repeatedly. In addition, to strengthen the
validity of the extracted content, a number of
coded interviews were returned to the
participants to allow for member reviews. The
reliability of the findings was assured through
professors' reviews. (i.e., after the interviews,
the professors who were not involved in the
data collection process, listened to the
interviews, compared them with the written
text, and applied the necessary changes.
In order to verify, the researcher tried to not
enter his/her assumptions in the data collection
and analysis processes. The transferability of
the data was assured through revision by five
women who were not involved in the research
process. The interviews lasted 50-90 min and
sampling continued until saturation of the data.
Concurrent with the data collection process,
data analysis was performed. At first, each
interview transcript was read several times and
the initial codes were extracted. Thereafter, the
participants' phrases and keywords were
identified and then the initial codes were
revised into analytical codes. Then, after
modifications, the codes were organized into
basic theme, organic theme, and global theme.
In the content analysis phase, the researcherTherapy, Spirituality, and Spiritual Well-being
51 Health, Spirituality and Medical Ethics - Vol.7, No.1, Mar 2020
extracted a series of fundamental concepts and
patterns and then categorized the obtained
data. Finally, the global theme of seeking
treatment through spiritual means was
extracted.
Prior to conducting the interview, the role of
the researcher, subject, and purpose of the
research were explained to the participants.
The interviews were recorded after obtaining
the permission of the subjects, and in any part
of the interview, if the participants were
unwilling to let their voices to be recorded,
interviews were paused and the researcher took
notes.
Result
A total of 30 female tourists with the age
range of 18-55 years participated in the present
study. The subjects’ educational background
varied from diploma to PhD. The findings of
the current study showed that the concept of
pilgrimage was composed of eight themes and
the global theme was seeking treatment
through spiritual means. Table 1 demonstrates
an overview of the global theme (seeking
healing through spiritual means), organizing
themes (discovering existential meaning, sense
of place, spiritual action, emotionalism,
connection, miraculous treatment, renewal and
remembrance, and purposefulness). In
addition, it presents the main themes of the
present research.
Based on the findings of the present research
and the thematic and multi-step analysis that
followed the multiple and repeated coding of
the research findings, the global theme of the
pilgrimage was “to seek treatment through
spiritual means”. Therefore, pilgrimage as a
phenomenon that heals and treats the tourists is
analyzed and interpreted. The themes that
constitute this organic theme are “discovering
existential meaning, sense of place, spiritual
action, emotionalism, connection, expectation,
miraculous treatment, renewal and
remembrance, and purposefulness”.
Based on the findings of the study, we found
that sacred places provide ways to improve
and cure tourists at some levels. According to
the participants’ accounts, pilgrimage and
visiting the sacred places push tourists to
discover their existential meaning, through
reflection in a spiritual place and the spiritual
actions that they perform. Holy places help
them to reach an inner satisfaction and through
the connections and expectations of the sacred
place, they could reinforce their beliefs and
fulfill their wishes. In addition, the holy places
help them to restore their psychological,
mental, and even physical health at any stage
of the travel, including before the travel,
during, and at the sacred place.
Table 1. global Theme of Seeking treatment through spiritual
means
Organic
Themes Basic themes Examples
Discovering
existential
meaning
Self-observation
Self-reflection
Discovery of meaning,
internal and external
transformation,
contemplation, freedom
from material structures
Sense of
place
Spiritual
atmosphere
Magnetic force
Realm of silence
Presence of Imamzadeh,
architecture, fragrant
atmosphere, solitude,
spiritual energy
Spiritual
action
Ritualism
transaction
Acceptance
vow, sadaqah, charity,
endowment, waqf
Emotionalism
Relief
Emotional energy
Excitement
Peacefulness, spiritual
need, a surge of
emotions, impressiveness
Connection
Spiritual
connection
Earthly connection
Good mood, connection,
interaction with other
pilgrims
Miraculous
treatment
Healing
Karamat
Miracle
Cure, freedom, treatment,
peacefulness, solved
problem
Renewal and
remembrance
Religious beliefs
vow
Faith in God, become
innocent, servitude
Purposefulness
Inner satisfaction
Excellence
Rebirth
Personal growth,
meditation, promotion,
personal growth self
awareness,
Discovering the existential meaning
Regarding the discovery of the existential
meaning, extracted themes from the
participants’ opinions included self-
observation and self-reflection. Search for
meaning drives mankind toward different
places (e.g., known and unknown, far or near,
man-made and natural) (21). Participants
stated that visiting these sacred sites provided
an opportunity to contemplate their own
existence and to make some evaluations. The
participants’ search for privacy was in line
with this reflection and contemplation.
Self-observationMoaven Z
Health, Spirituality and Medical Ethics - Vol.7, No.1, Mar 2020 52
In the ethnographic experience of these
places, some tourists engaged in dialogues or
laughter and empathy, and some with patience
and confidence examined their actions and
behaviors, sometimes even they did not feel
the passage of time and were trapped in their
spiritual realm of their inner world.
Marzieh, 30-year-old:
"I always try to find a place of solitude, to
look for a cozy place, then I start to speak with
God, I talk about my actions, behaviors, and
all the things I've done, I tell everything"
Self-reflection
There are different categorizations of the
holy places’ tourists and the common
characteristic among them is that they believe
visiting holy places is an opportunity for
contemplation. The value of this reflection and
thinking is not less than worshiping and
performing the rituals. It is this reflection and
thought that helps the tourists to lead a better
life.
Mahsa, 25-year-old:
"In my opinion, these places are not just for
worship and pray, I come here to think, to see
what I’ve done and what should I do, what I
can do to change, to get better; so, here I am
trying to feel free, I'm not looking for
boundaries, as if here gives you an opportunity
to just sit down and think”
Sense of place
Search for spirituality drives people to
different places. It is the influences that these
places have on people that show the power of
these holy and sacred sites. Holy places
possess an intrinsic property of attracting the
seekers and quenching their thirst for the truth.
Pilgrimage travels change a person and
reinforce their adherence to performing good
deeds. The combination of reflection, contact,
prosperity, and well-being give people the
required energy to understand and affirm
higher human goals. After understanding their
place in the system of existence, these travelers
find themselves compelled to question
everything and open-mindedly devote
themselves to harmonizing with the society
and environment and to pay attention to the
welfare of all three components of (self,
society, and environment). Spiritual journeys
help one to be free his heart and soul and
understand the meaning of life. Spiritual
pilgrimage enables individuals to see
themselves and others as one and to join a
network of homogenous communities (21).
Spiritual atmosphere
Light, color, mirroring, fragrant atmosphere,
and architecture of the holy places and the
energies that resulted from the presence of
tourists in these places create a special spiritual
atmosphere and it affects the tourists’
behaviors. They felt affected from the moment
they stepped into the place and their zeal for
pilgrimage doubled healing all of their
difficulties. A tourist’s account of this
experience in the form of a semi-structured
interview is as follows:
One-hour interview with 45-year-old Zainab:
“Spirituality and architecture of these places
are very influential, they completely change
your mood, when you enter into these places,
you feel relaxed and it is like a cool breeze
across your face”.
Magnetic force
Elements that made the sacred places to look
impressive along with the provision of a
relaxed and hospitable environment for
reflection and thinking emitted positive
energies. Tourists referred to these energies as
magnetic forces, energies that pulled them
toward these holy places and encouraged them
to perform the religious rituals with special
enthusiasm.
Throughout the conversation, Taherah
enthusiastically referred to the design,
architecture, and coloring of the shrine.
Elements that make the tourists feel that they
entered into a totally special and different
environment. Tahereh’s narration is as follows:
Tahereh, 22-year-old:
"All the elements in this place are like
magnets, they all attract you, from glassworks
to the zarih".
Realm of silence
The participants believed that visiting a
sacred place should be accompanied by special
practices and rituals, including the expression
of humility and servitude in the presence of the
Almighty and keeping silent before him.
Consequently, some people believed thatTherapy, Spirituality, and Spiritual Well-being
53 Health, Spirituality and Medical Ethics - Vol.7, No.1, Mar 2020
visitors should not behave in any way that
disturbs the peace of these sacred places or
prevents the rituals from being performed
correctly.
Fatima's experience of being in the holy
place referred to escaping from the hustle and
bustle of the outside and searching for a place
that comforts her.
Fatima, 26-year-old:
"I love the ceremonies in the holy shrine, but
all of them are performed in groups. I'd like to
be where I can sit back in silence and think.
Sometimes the whispers of the other visitors
disturb me, but I want to be left alone".
Spiritual action
Spirituality was always present in each action
or behavior in sacred places. Given the
intentions and motivations of the tourists for
traveling to sacred places, they performed
practices that had influence both on themselves
and others. Therefore, these practices are
considered to be invaluable.
Ritualism
Religion consists of two basic elements of
beliefs and deeds. Beliefs are ideas and deeds
are ways of social action. Some of the
religious practices (e.g., rituals) are an integral
and important part of any religion which can
be the source of many developments in social
life (22). The ritual dimension "encompasses
the specific religious practices that followers
of any religion are expected to perform" (23).
Tourists believed that they were bound to
perform religious rituals that began before the
pilgrimage and continued them until after the
pilgrimage. They believed that they should
perform certain rituals before traveling to a
holy place, while at the place, and after the
pilgrimage. The degree of their adherence to
the rituals is based on their passion for the holy
place and Imamzadeh.
Performing these rituals, in addition to
assuring them that they have performed their
religious deeds as God ordered, also provide
them with a degree of reassurance:
Haniyeh, 49-year-old:
"From the moment that I step out of my
home by the time that I get to the shrine, I
pray. I feel like if I don't do this, my
pilgrimage will not be accepted, I will not feel
good otherwise”.
Transaction
Some tourists bargain for the fulfillment of
their wishes and sometimes it is very important
to them to evaluate how important their wish
is, to give more assets. This exchange is made
in forms of gift, sadaqah, charity, endowment
(i.e., waqf).
Mahin, 54-year-old:
"Last time that I came here I made a vow that
if I heal, I will donate the carpet that I’ve
weaved. Alhamdulillah, I've got what I
wanted. So, this time I brought the carpet, I'm
very happy".
Acceptance
Tourists believe that unlike other places,
there are special requirements for getting
invited into sacred places. Those who are
invited should ask for permission to be
allowed to enter into the sacred place. For
some tourists, it is extremely important that
they feel that they have received permission to
enter into the holy place and they understand
whether they have the permission or not
through changing their moods or feelings.
The feeling of wanting and being invited
created special joy in the visitors’ hearts.
Shabnam was one of those visitors who spoke
enthusiastically in this regard:
Shabnam, 39-year-old:
“You should be invited to such places, you
can’t go on your own. Then after you are
invited, there are some rules that you have to
obey, you should ask for permission and then
they may accept you. In this way both you and
they wanted you to be here”.
Emotionalism
Emotion is an integral part of religion, as
religiosity always encompasses emotions.
Emotion is both personal and relational,
private and social, living and cultural.
Religious emotion is built not only through
social communication but also through beyond
social communication as well (e.g., sacred
affairs, sacred industries, and sacred texts)
(24). Many tourists experience different
emotions when they are in a sacred place and
they show these emotions in various ways.
These feelings are promising since they areMoaven Z
Health, Spirituality and Medical Ethics - Vol.7, No.1, Mar 2020 54
signs that tourists will benefit from visiting
these holy places.
Relief
Being present in sacred places and
experiencing different kinds of feelings has
brought some transient or permanent relief to
the visitors. They were so relieved that even
some of them stated that they have forgotten
what reason brought them to these holy places
in the first place. This peacefulness transferred
them from a tumultuous outer world to a safe
haven.
Fattaneh, 36-year-old:
"I prefer the shrine of the Imams and
Imamzadehs, their holiness gives me peace, a
while ago I was disturbed but now I feel so
relaxed that I do not know why I came here in
the first place."
Emotional energy
Faith and belief as sources of emotional
energy guide the visitors to perform their
religious duties and interact with other tourists
and help them to express themselves in
different ways by showing their emotions.
Sakineh, 19-year-old:
"In this place, I feel more and more that I
have faith in the power of God. I believe that I
can rely on him, this makes me feel his
presence; therefore, I’m sure that he hears my
prayers, solves my problems, and helps me to
feel good”.
Excitement
Pilgrimage is often accompanied by specific
emotions and excitements that affect visitors.
Some participants mentioned specific emotions
that had only been experienced in the sacred
places and they did not experience these
emotions before, and others spoke of their own
emotional experiences.
Marjan, 21-year-old:
“Ever since I arrived here I start crying from
happiness, I got goose bumps, the moment I
saw the Zarih I could not swallow back my
tears anymore and burst into tears, I just
wanted to cry out loud"
Connection
Pilgrimage provides a platform for people to
spiritually connect to each other. It makes
them feel spirituality and start some inner
transformations in themselves. Visitors regard
this connection as a starting point for the
transformation. In their view, for achieving an
effective connection, some conditions are
required and sometimes these conditions are
related to the intentions of starting pilgrimage
travel.
Spiritual connection
The connection of religious tourists in the
sacred place is sometimes purely
psychological and spiritual and this connection
is achieved through the connection between
the heart of the pilgrims and God and
Imamzadeh. Their effects are manifested
through the expression of emotions and
excitements.
Safura, 19-year-old:
"I try to get in touch with the God or
Imamzadeh anytime possible, I feel this
connection when my heart is broken,
especially when I ask for permission to enter
into the holy places and I say that if you don't
want me to come I will return to where I came
from and by saying this I burst into tears”.
Earthly connection
A significant part of the connections in the
sacred places is through bonding and
interaction with other visitors which plays a
significant role in the improvement of the
mental state and healing of visitors, thereby
transmitting one's religious and social
experiences to one another. It has an important
role in changing people's moods and lifestyles.
Mahin, 29-year-old:
"In this place, not only can you talk to your
God, there are times when you try to interact
with the person who sat next to you, you can
even befriend her".
Miraculous treatment
Tourists have turned interest to pilgrimage
therapy. They believe that pilgrimage provides
an opportunity for different people with
different opinions to assemble in a sacred
place and to develop a spiritual and social
connection. The result of this assembling and
connection is the achievement of the
psychological relaxation that has its effects on
various aspects of visitors' life.
Healing
Many visitors believe in healing and seek
healing from sacred places. They visit theseTherapy, Spirituality, and Spiritual Well-being
55 Health, Spirituality and Medical Ethics - Vol.7, No.1, Mar 2020
places to pray for the health of themselves,
their friends, and relatives and to ask the
Imamzadeh to mediate between them and God.
Soraya, 52-year-old:
"I came here since I want my daughter to be
healed, I am sure my presence here on this
blessed month was not without reason, I am
sure that I see a miracle"
Karamat
Some visitors believed in the Imam's
karamats and they aspired to be bestowed by
these karamats.
Safia, 47-year-old:
"God have mercy on me, solve my problems,
I hope he forgives me, I do not want to return
empty-handed"
Miracle
And some others believed in miracles
because they had no other choice. On one
hand, they were disappointed with others and
on the other hand, they considered their desire
so enormous that thought only an ultimate
power capable of granting miracles could
fulfill their wishes.
Zinat, 35-year-old:
"All doctors said that they ran out of options,
they said they can't do much, but I believe in
miracles, today is the fifth day that my
husband is in a coma, I have no one except
him. The moment doctors said that they can't
help anymore I bought a ticket to come here
and to be here at this Friday night which is
Kamil prayer night, I do believe in his
miracles".
Renewal and remembrance
People who visit the sacred places are
looking forward to renewing their experiences
and religious practices. Since they want to
break free from routineness and lethargy of
modern life, they look for a source to gain
spiritual energy. Consequently, they visit the
holy places.
Religious beliefs
Religious beliefs of the visitors constitute an
integral part of the pilgrimage, which remind
them by their presence in the sacred places and
they show themselves actively and
dynamically in prayers and religious duties.
Fatima, 20-year-old:
"Pilgrimage is a reminder of the faith, the
things you have learned, things may have now
faded, you remember these kinds of things in
these places, especially when you pray or read
the biography of Imamzadeh".
Vow
Visitors mentioned a mutual renewal of
covenants with the Almighty God. They
believed that this covenant was attributed to
the Imams and Imamzadehs.
Zakieh, 53-year-old:
"I vowed that if the Imamzadeh interceded
and God hears my prayers, I would come here
once a year, but not just come once or twice,
try to keep it going".
Purposefulness
Visitors stated that they started the journey
with pilgrimage purposes and sought to attain
internal and ethical development by acquiring
epistemological knowledge; therefore,
achieving inner excellence and satisfaction.
Excellence
The visitors acknowledged that their goal of
the pilgrimage was to reach excellence, which
was often accomplished by growing and
changing themselves.
Hamide, 48-year-old:
"I hoped that pilgrimage would make me
change for the better, both mentally and
socially. I've learned so much from my
travels".
Inner satisfaction
Satisfaction resulting from pilgrimage can
bring inner peace to visitors and it is very
effective in improving their mental health.
Razieh, 24-year-old:
"When I take a break from daily life, I sense
that I have a special feeling as if I have been
comforted from the inside and I've got
whatever I wanted"
Rebirth
Pilgrimage creates an opportunity for tourists
to reborn. After the pilgrimage ends, they feel
clean and new in the body and soul. They
believe that since they feel like they were born
once again; therefore, when they back to their
daily lives and they will apply this sense of
freshness into their daily routine and personal
lives.
Marzieh, 55-year-old:Moaven Z
Health, Spirituality and Medical Ethics - Vol.7, No.1, Mar 2020 56
"Today that I'm coming back from the holy
shrine, I'm relieved, I feel like I was just born,
I'm feeling carefree, with no sadness, I feel so
good that I can't express".
Discussion
Tourists are mostly interested in visiting
sacred sites and having unique experiences.
There are numerous incentives that encourage
people to choose sacred places as a traveling
destination. Apart from happiness, other
motivations are including, healing and
wellness. Health is one of the top priorities in
daily life and the sacred places are where
recovery is expected to be achieved through
social, emotional, and spiritual interactions
until the person reaches his/her desires.
Given the importance of sacred places and
peoples’ expectations from them, the purpose
of the present study using ethnography and
thematic analysis technique was to answer the
following question of how spiritual therapy
and spiritual well-being is achieved through
visiting the sacred places.
The recording of women's narratives showed
that sacred places were important sites that
provided a good platform for women to reach
self-knowledge, interact socially, act
emotionally, and transform internally.
In addition, the participants indicated that
these places had special features that attracted
them, such as unique design, security,
peacefulness, and collaborative action.
The researcher’s observations demonstrated
that these days, pilgrimage travels play a key
role in the treatment and healing process, and
sacred places are of prime importance
regarding this matter.
In the current study, women stated that they
seek to discover their existential meaning
through contemplation and self-observation in
the sacred places, particularly the sense of
being in a spiritual place was important to
them.
Pilgrimage of a sacred place is like a journey
in search of truth, a journey to a place that is a
reflection of divine power and providence. In
other words, the search for truth and
enlightenment entwined with the divine and
sacred concepts inspires people to visit these
places as they go beyond ordinary daily life. In
such places, one does not consider the basis of
the relationships as materialistic; however,
"metaphysical and supernatural searches
throughout history" draw people to places
where they feel free from the mundanities of
the earthly life (28) with the aim of getting out
of confusion. In fact, the sacred places provide
an opportunity for tourists to contemplate,
away from the chaos of everyday life and to
gain insights and discover their existential
meaning. Therefore, to become remote from
the sense of absurdity that sometimes engulfs
them.
Holy and sacred places evoke a unique
feeling encompassed by different experiences.
Internal and external needs bring people to
these places and a set of elements that exist in
these places have an influence on tourists and
create an aspiration in them to fulfill their
desires and expectations. Ultimately, these
spiritual atmospheres and received spiritual
energies from these realms of reflection
provide tourists a sense of well-being or inner-
exterior-peace.
The created connections are spiritual and
materialistic connections that on the one hand,
affect the spirit of the tourists and on the other,
connect them with others, which they are
regarded as a source of comfort. Pilgrims build
a closer relationship with God by going on
pilgrimage and visiting sacred places gives
them a sense of psychological security. A
sense of closeness to God leads to a greater
satisfaction with life and they promise to stay
away from deviations (25).
The results of the current study indicated that
part of the women's intention for entering into
the religious sites was to perform spiritual
activities that some of which play a major role
in filling the women's emotional and spiritual
void. Turki showed that a place of worship is
where people become detached from the
mortal and materialistic worlds, say prayers,
and reach spiritual comfort (25). The
abovementioned findings were in line with the
results of a study conducted by Vasokalaie
(26).
Furthermore, visiting sacred places makes
tourists spiritually relaxed. The resultantTherapy, Spirituality, and Spiritual Well-being
57 Health, Spirituality and Medical Ethics - Vol.7, No.1, Mar 2020
spiritual change of the visitors is demonstrated
through different emotions. It renews the
feeling of vitality and happiness in them and
shows its effects in other parts of the journey
and the visitors' lives and assures them that the
purpose of the journey has been fulfilled.
Hope in mankind is what makes his efforts
meaningful and gives strength to him.
According to the surveys, every living creature
performs its daily activities with hope (27).
Since treatment sometimes is received
miraculously from the sacred places, the
participants of the present study stated that
they sought it through pilgrimage. In fact,
sacred places become places for demanding
the fulfillment of their needs. Although these
desires and ways of fulfilling them may
require extraordinary powers (e.g., miracles),
the pilgrims' hope, faith, and belief make them
attainable. They believe that everything is in
God's hand.
The results of the present study indicated that
from the beginning of the pilgrimage, tourists
expect that every step that they have taken in
order to visit the Imamzadeh will help them to
be forgiven after death. Therefore, they keep
their vows and renew them by continuously
visiting holy places.
As it was shown in the study carried out by
Warfield, the pilgrimage had a significant
impact on the visitors' views of their lives,
relationships, identities, and their future plans.
From the perspective of mental health service
providers, access to knowledge about previous
(or sacred) travel is important (9). The current
findings also confirmed that the pilgrimage
begins with a purposeful journey and visitors
plan for their journey from the beginning.
Female visitors stated that spiritual excellence
mattered the most to them. This spiritual
excellence is achieved through faith,
strengthened communication with the
Almighty, and remembrance and renewal of
beliefs.
The categories of the discovery of existential
meaning, sense of place, spiritual action,
emotionalism, connection, expectation,
miraculous treatment, renewal and
remembrance, and purposefulness form a
global theme of seeking treatment through
spiritual means.
Traveling to sacred places for the sake of
therapy reflects a desire to be present and have
access to places beyond the confined spaces of
daily life. Places that enable individuals to
focus on their physical, emotional, and
spiritual pursuits and expect them to become
fulfilled. Achievement through spirituality is
the way that they seek their healing. The
categories of the discovery of existential
meaning, sense of place, spiritual action,
emotionalism, connection, expectation,
miraculous treatment, renewal and
remembrance, and purposefulness are among
the means that pave the way for achieving this
purpose.
Conclusion
Based on the findings of the current study,
healing and spiritual well-being are achieved
through visiting sacred places. Since these
holy sites provide an appropriate context for
interactions, actions, ritual and worship, and
emotional evacuation. Some of these practices
are in the form of collective cultural programs
and some individually. In the meantime, the
tourists' expectations of being in such cultural
and spiritual setting and the impact that the
atmosphere has on them should be considered.
This expectation is that they believe cure and
improvement will be achieved by visiting these
places.
The results of the present study indicated that
sacred places by providing a secure
environment drag the tourists out of the chaos
of the outside world and help them to have a
deep transition and begin a profound
transformation. In the meantime, the impact of
this atmosphere entwined with cultural and
spiritual programs is very influential to let the
tourists to emotionally evacuate themselves.
Emotional states that are created under the
influence of the sacred places are very
important in establishing the earthly and
spiritual connections, because the stronger the
spiritual connection is, the more they fulfill
their purpose of pilgrimage. As the purpose of
visiting the sacred places is to heal throughMoaven Z
Health, Spirituality and Medical Ethics - Vol.7, No.1, Mar 2020 58
receiving karamat and transformation of their
inner feelings.
Presence in the sacred sites is accompanied
by the renewal and remembrance of religious
beliefs. It is a renewed covenant with the
almighty and a way of avoiding laziness.
Ultimately, at the end of the pilgrimage,
reaching their goal that they have started the
journey for, is the only thing that is important
to the tourists. This goal is a sense of inner
satisfaction. This satisfaction is not only
effective in improving the psychological well-
being of the tourists but also it is regarded as
an opportunity to feel reborn. Now, s/he is
born once again physically and mentally and
returns to his/her personal life with a different
sense of purpose.
Accordingly, it can be stated that spirituality
in tourism and pilgrimage is of great
importance today and there have been efforts
to improve and ameliorate different aspects of
life. Therefore, resulting in attraction of
attention toward pilgrimage tourism. Today
more than ever, the search for healing through
spiritual means attracts the seekers of spiritual
well-being to itself due to the inability of the
earthly means to provide the most essential of
human needs, namely peace.
Understanding the relationship of healing,
spirituality, and spiritual well-being with the
sacred places can promote a very different
perspective that helps us to provide solutions,
to help, and treat believers and even non-
believers. Because believers, those who are in
search of meaning and spiritual well-being can
accomplish their wishes through the
reinforcement of hope, faith, purpose, and
pilgrimage travels, as well as they can achieve
spiritual and psychological healing. Moreover,
the non-believers can be comforted and
soothed through contemplation and emotional
evacuation. Therefore, most people these days
search for healing through spiritual means to
ensure their spiritual well-being.
Conflict of interest
The author declared no conflicts of interest
regarding the current research project.
Acknowledgements
The authors' sincere appreciations go to those
who assisted us in conducting the current
research, especially to the authorities of holy
places in Shiraz who issued the approval to
carry out the present project. Furthermore, our
sincere gratitude goes to the tourists
participating in this research.
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mental health and the excellence of the soul.
Proceedings of the Thought of Pilgrimage, Qom,
Mashair. 2008;1:23-50. [Persian] link
26. Rahmani Vasokalaie M. Healthy society depends on
spirituality (with emphasis on the role of pilgrimage).
[Persian]
27. Tix AP, Frazier PA. The use of religious coping
during stressful life events: main effects, moderation,
and mediation. J Consult Clin Psychol.
1998;66(2):411-22. link
28. Timothy DJ, Olsen DH. Tourism, Religion and
Spiritual Journeys. USA: Rutledge; 2003. p:18
Type of Study: Original Article |
Subject:
Special
Received: 2019/05/30 | Accepted: 2019/12/8 | Published: 2020/03/1
Received: 2019/05/30 | Accepted: 2019/12/8 | Published: 2020/03/1
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