The Yale Journal for Humanities in Medicine

Summary

We can now describe spirituality in all its elements. Spirituality is a mode of being that appears to be the mainspring of the tendency towards good/evil within us. We appear to ourselves as driven by this spiritual tendency, restless in our need for wholeness, and search for meaning, sharing with others a vision of the Sacred, the responsibility of civilization in the attainment of that vision, and the development of a better world where unity, peace and compassion abound. The spiritual tendency towards good and evil appears to be inscribed in our hearts. We become whole as we allow this powerful force within us to emerge, not only to empower ourselves, but others, and the environment. One of our most cherished gifts is freedom. We can use that gift to refuse the responsibility of a person-making process, or we can use it to be in harmony with self, others and the environment. The presence of God in each of these relationships creates the sense of belonging to something bigger than oneself. The chart on the next page expresses stages of growth and stages of disunity. In each individual, some elements of the push/pull tendency of spirituality takes roots on the side of good, and on the side of evil. We aim for spiritual perfection, and seek to avoid evil, but the human condition is such that we accomplish neither in full. However, the claim evil has on us is lessened once we become aware of its existence in us. The chart is a person-making navigational system. It is used as a guide to making a moral inventory of ourselves. For instance, the left-hand side of the page suggests negative ways of feeding spiritual energies whereas the right-hand side focuses on success stories. The individual should spend some quiet time ‘soul-searching’ before moving on to a spiritual assessment.

THE GEOGRAPHY OF SPIRITUALITY
DARK SIDE	(Push/Pull Tendency)	LIGHT SIDE
Evil	(Human Heart)	Good

Movement Towards Disunity	RESTLESSNESS	Movement Towards Unity
Illness Addiction	SEARCH FOR MEANING	Curing and Healing Good Habits
	LIVED EXPERIENCE OF REALITY
Social Self: The other as hell	(Narrative)	Social Self: The other as love
Environmental Self: Exploit nature		Environmental Self: Nature as Sacred
Internal State: Despair		Internal State: Hope
	UNITY--CARE--COMPASSION
Disintegration		Dynamic Unit
(Death)		(Life)

The main play is spiritual welding. The role of care giver is to identify places where a patient/client is broken (divided) and the search for meaning is frustrated. Spiritual welding is about putting Humpty Dumpty back together again. The nurse/counselor listens to a patient/client story to discover the locus of broken relationships and to determine what technique can be used for re-connection with the spiritual tendency. Religion is one of the tools that connects with spirituality. The healing effects that prayer, Sacred writings, religious rituals, and symbols have on the faithful are well known. But religion is only one of the many ways of becoming whole. Other techniques that can be useful in spiritual welding include art, dance, exercise, Journaling, meditation, music, play, and therapeutic touch, to name a few. Healing is about finding places in associations where the search for unity is interrupted and welding them in place. Story telling is a useful method for uncovering an individual’s lived experiences. The nurse/counselor uses the narrative to understand what technique(s) are best suited to the patient/client’s needs and wants. The environment where client and counselor meet must be inviting (safe space). It must introduce right-brain insight to left-brain logic and address the whole person. Music provides an instance of healing. For example, it can reduce the nausea and vomiting associated with chemotherapy (Mozart effect). Art also has a healing effect on relationships, though the choice of art is individualistic. Dance, play, nature, each technique has effects that can rival the power of religion, and prayer. Healing techniques vary depending on material (relationships), type of break and welder.           

Spirituality Assessment

There is no shortage of spiritual assessment scales to measure the search for meaning. The main difference between what is presented here and what exists in the literature is the focus on relationships and the inclusion of the Sacred on the arms of the person-making process. The questionnaire marks but one glimpse of a changing landscape. Careful spiritual assessment is the gateway to holistic intervention. Two stages mark the process of a successful intervention. First, as nurses/counselors become more familiar with their own spirituality, they will be more attuned to the spirituality of others, as argued above. Second, there is a need to develop a method for collecting data on the patient/client’s spiritual journey. This is phenomenology.  The method is ideally suited to the task at hand because one of its chief features is the focus it places on the unitary character of knowledge. One of my cherished beliefs is a claim made by Martin Heidegger that the expression ‘the thing-in-itself’ refers neither to the thing outside of consciousness, nor to the subjective correlate of consciousness, but to a mode of encounter superimposed upon the two in such a way as to make the encounter possible. Think of the self that way!

The Phenomenological Method

The phenomenological method is ideally suited to the task of taking a patient/client spiritual history. The objective is to provide an objective insight into that history. To this end, the nurse/counselor encourages the use of narrative. First the individual is encouraged to relax the security grip of logic. The use of healing techniques suggests that things don’t always have to make sense to have value. The world of feelings and emotions has a logic of its own, a logic which reason does not understand but nonetheless provides a vital role in healing. The narrative form is used to express the rich language of a lived life. In story telling, the individual talks about his or her search for meaning. And the push/pull efforts of a spiritual tendency surfaces as the individual talks about successes and failures in reaching harmony with the deepest part of self, other persons, and the environment. The narrative form provides the attentive listener with an insight into ways of caring, ways of assisting in the re-connection process. The therapist nurse/counselor accomplishes that objective through a series of reductions or steps designed to suspend the interpretive bias he or she unwittingly brings  to a case study. The method enlists steps to ensure that the encounter with the client/patient reveals the world of that individual without interpretive bias.

The method begins with an ‘epoche’ or suspension of judgement about anything that can interfere with pure listening. For example, if the patient is homosexual or lesbian, the therapist must become aware of his or her possible bias against sexual diversity to ensure that they not interfere with the client narrative. Once the client/patient is made to relax, the next step is a ‘phenomenological reduction’. The effort is directed towards the creation of an environment in which the client freely allows (painful) feelings to parade in his or her stream of consciousness. Those feelings include the loss or shift in spiritual meaning caused by an illness. Several steps are enlisted to facilitate the process. First is a ‘bracketing’ in which a central issue is identified for intensive exploration. The issue is central in the sense that the individual sees everything else in light of it. For example, a cancer patient can feel that he or she is becoming an increasingly heavy burden on family members. ‘Horizontalization’ follows up on what is bracketed. The patient is encouraged to identify all the possible strings associated with the expressed concern. The goal is to list all possible strings connected to this loss of meaning to guard against selective listening. It may be necessary to return to this step time and time again. It involves patience. Gradually, a unified reality emerges and a picture of the whole is constructed.