YJHM: Kenneth A. Bryson, "Spiritual Welding 101"

Clark Moustakas (1988), visiting professor of psychology, Family Life Institute of the University College of Cape Breton,^[x] uses the ‘eidetic variation’ to ensure accuracy. The step examines possibilities, views, perspectives, directions or approaches that might offer new frames of reference, or new meanings for altering a client/patient’s sense of life. He suggests several techniques, including ‘free fantasy’ in which the individual is encouraged to fantasize on all the possible meanings connected with the bracketed phenomenon. For example, the client/patient’s narrative focuses on how others outside the immediate family view the situation. This approach offers a fresh perspective, and can lead the intervention back to ‘horizontalization’ for a second look.

Christina Puchalski (2002) has found that forgiveness is at the heart of healing. It results in greater peace of mind, healing of old emotional wounds, and better relationships;^[xi] “A lifestyle characterized by forgiveness is often thought to be also characterized by love, empathy, humility and gratitude.” (5) All of these virtues enable a person to experience greater meaning in the relationships that characterize life. The following questions are posted on the arms of the person-making process as a simple but effective roadmap to these virtues. The wording of the questions can be fine tuned to meet the particulars of a case, though the view that a patient as the output of relationships is unchanged. The intent of holistic healing is to examine these relationships for loss of meaning so that the movement towards wholeness can begin anew.

Questions Concerning the Inner Self

What gives my life meaning?................................................................

What values and beliefs are most important in my life?..............................

How I feel about myself (at peace, or anxious)?......................................

How does my illness change the way I find meaning in life?........................

Do I feel connected to God (Higher Power)?............................................

How do I cope with my illness?.............................................................

Other?.............................................................................................

Questions Concerning the Social Self

What relationships are most important to me?..........................................

Do I have the support of my church community?.......................................

Is my family supporting me in my illness?.................................................

Are my friends supporting me in my illness?..............................................

How do I feel about others (resentments?)..............................................

Am I fond of a pet?.............................................................................

Do I have the support of my work environment?. ......................................

Do I belong to a support group (Church community, 12-Step, other)?.............

Other?................................................................................................

Questions Concerning the Environmental Self:

What I miss about home (house, apartment, room, neighborhood)? ................

How is my hospital room (bed, furniture, color scheme, pictures)?...................

Do I find meaning in nature?....................................................................

Do I find the Sacred in nature (God, Higher Power)?.....................................

Would I like to be in nature at this time?....................................................

Other?.................................................................................................

Concluding Remarks

While the goal of a spiritual assessment is to identify a patient/client history to find meaning in extraordinary times, the search for meaning cannot go on at the expense of the care giver’s peace of mind. The care giver’s work environment needs to support the vision of ‘spiritual welding 101'. Caretakers also need ‘good relationships’ in their own person-making process. This means finding ways to cope with their own powerlessness when dealing with a terminally-ill patient, or cases of dementia, and such.

When curative treatment fails, the focus builds upon spirituality assessment to add the dimension of quality of life. This factor continues the critical role of spiritual healing in the life of a patient, but expands it to include special interventions to meet the particular effects of a disease. Quality of life is a subjective issue since it varies, not only culturally, but from person to person depending on factors like age, religion, education, and socioeconomic factors. For instance, one patient can rate a debilitating condition positively, while someone else rates the same condition negatively. Palliative Care Programs define quality of life as maximizing patient and family comfort across all areas of spiritual wellbeing. The determination of quality of life can be made on the arms of the person-making process by expanding it to include additional variables like pain management and hand feeding. For example, the Edmonton Symptom Assessment System (ESAS)^[xii] determines a cancer patient’s quality of life by measuring nine symptoms common in cancer patients, namely, pain, tiredness, nausea, depression, anxiety, drowsiness, appetite, wellbeing, and shortness of breath. The severity at the time of assessment of each symptom is rated from 0 to 10 on a numerical scale, where 10 is the worst possible severity and 0 means that the symptom is absent. The patient circles the most appropriate number on the scale. The patient’s assessment of symptoms can be downloaded onto the arms of the person-making process into the categories of inner self, social self, and environmental self. This provides a valuable map, not only to monitor a patient’s degree of comfort, but to ensure that everything possible is done to express that person’s best interest. The distinction between being human and becoming persons is critical. Once we shift the definition of being human from an abstract theory of human nature to a vision in which relationships are seen to define us, everything falls into place. The move from the Cartesian view of a disembodied ‘I’ that looks out at relationships to the associations that generate the ‘I’ sets the stage, not only for the development of a spiritual scale, but for even bolder projects like the next step: quality of life welding 102.

The Yale Journal for Humanities in Medicine