The Yale Journal for Humanities in Medicine

Kenneth A. Bryson is a Professor of Philosophy at the University College of Cape Breton. He teaches courses on spirituality/religion and health. He has published several books on death and dying and is series editor of the Value Inquiry Book Series (VIBS) special series in Philosophy and Religion.  

Abstract

Spiritual Welding 101 is about basic spirituality and healing. Illness is a division between mind and body. The person who is ill does not function as a dynamic unit. That person is broken. Medicine can fix the pieces, but spiritual welding puts Humpty Dumpty back together again. An apprentice must first learn the basics of welding, what pieces go where and why.  

Key words: assessment, curing, disease, dualism, healing, illness, mind-body, person-making,  phenomenology, spirituality, welding.

Introduction

The distinction between healing and curing is important. When medicine focuses on the physical person, the goal is to cure disease, but when medicine focuses on the whole person, the goal is to heal as well as to cure. Healing enlists all components of a person’s life, the environmental and the social, as well as the biological and the psychological. Dave Hilton, past associate director of the Christian Medical Commission at the World Council of Churches, tells this story about coming to understand the difference;^[i] 

One day a young boy (from the Seminole tribe in Florida) was brought to a clinic after falling from his bike and breaking an ankle. Hilton says he set the ankle, put a cast on it and sent the boy home. Later in the day he went to talk to the medicine man of the village who told Hilton that he had just come from visiting the boy with the broken ankle. The medicine man explained that he asked the boy the reason he broke his ankle. The boy responded that he did not know the reason. After talking for some time the medicine man asked the boy how he was getting along with his mother ... every part of the universe is represented by a part of the body. The left ankle for the Seminole, is the female. The Doctor had cured the boy but the Seminole healed him (1: 19).      

The goal of the paper is to provide an inclusive healing model. In 1999, I developed a distinction between being human and being a person that I think can be used successfully to identify the place of spirituality in holistic healing.^[ii] That model is used here because it provides a practical way of identifying the effects of spirituality in action. Spirituality is an integral component of holistic healing. The complementarity of curing and healing, illness and disease, body and mind is possible because we are dynamic units of inner self, body, other persons, and the environment. Another word for the inner self is spirit. Spirit is an aspect of mind. When the mind seeks knowledge, it is called the intellect. When the mind hungers for God, the Sacred or a Higher Power, it is called spirit. The spiritual drive is a force within psyche that cannot be silenced. The feeling of emptiness expressed in our day is a ‘soul sickness’. This suggests that the spirit is not fed, or is fed in negative ways. We are broken people, in a state of disunity looking to be whole. Illness and disease provide instances of mind-body disunity. But spirituality animates the desire to be whole. Feeding the desire material values  leads to addictions, and division (illness, and possibly disease). Addictions inhibit holistic growth. Feeding the desire positive spiritual values leads to unity, compassion, and good health. Religion used to function as healing tool, though in our day of secular humanism, it  has lost some of the appeal it once had. Still, the thirst and search for spiritual connectors is ongoing. We need to fill the void created by the loss of a religious connection. But like babies of old frowning at the horrid taste of castor oil, we squirm and reluctantly swallow our connectors. The right-brain spiritual connectors are forced fed into the bellies of left-brain brats. Our secular priests, spiritual leaders, swamis and gurus tell us spiritual values are good for us, but subjective values have to be welded onto the left-brain. We are on left-brain diets, and our spiritual anaemia worsens. But spiritual hunger is relentless, ever pressing ahead even if for artificial fixes.                                                                                       

In the beginning, we knew all about the connection between mind and body, unity and health. Medicine was not only about curing but also about healing and feeling good. Women already know this. They are the original healers. They know all about birthing, feeding, nurturing, and death. At one point in our history, things took a turn for the worse as we equated feeling good with having material things. We turned towards aggression and war to keep our material things. Paternalism, war, and the Church ran women out of the healing business. Our relationships with other persons and nature, as well as our peace of mind, took a turn for the worse. The Inquisition and Rationalism moved us forward. We tortured nature for her secrets, and used other human beings as a means to our thirst for control. Gradually, the belief in the power of religion, God, human nature, and global ethics were deconstructed. Henceforth we would design nature to our specifications, drugs for feeling good, and a God made in our image and likeness. But the triumphs of science also knew failures because violence, poverty, hunger, rape, and injustice keep escalating. We can no longer ignore the divisiveness of naturalism.     

Return of the Spiritual

Viktor Frankl’s (1984) Man’s Search for Meaning^[iii] has had a powerful influence on reversing mind-body dualism. As a prisoner in Germany’s concentration camps he saw the spiritual value of suffering. Those who survived the death camps were not necessarily the physically strong—since many of them simply gave up and died—but the ones who believed in the spiritual dimension of life.  They had a will to live that would not be crushed. They had hope and hope is a prelude to action. In our day, research into the ways of hope centres on neurotransmitters—chemical substances made by the brain and other organs that transmit nerve impulses. Neurotransmitters bridge the mind-body gap as they run back and forth between the brain and the nervous system telling every organ inside us everything about us. No emotion, thought, intuition, desire, memory, dream, experience goes unnoticed by the whole person. Norman Cousins, (1990) makes the point:^[iv]

The immune system is a mirror to life, responding to its joys and anguish, its exuberance and boredom, its laughter and tears, its excitement and depression, its problem and prospects. Scarcely anything that enters the mind doesn’t find its way into the workings of the body. Indeed the connection between what we think and how we feel is perhaps the most dramatic documentation of the fact that mind and body are not separate entities but part of a fully integrated system (p. 72).

Academics are the first to identify and label illnesses. Plato generally defines health as a harmony or balance, and disease as lack of balance or disorder. But academics also love to create problems. Two streams of thought exist on the meaning of health. In one camp, health and illness are taken to be biological concepts. This view reduces mind to brain. The other mainstream takes a completely different point of view. It maintains the distinction between mind and brain. Health and illness are  value-laden terms. This is the prevailing view today. Medical knowledge is practical as well as theoretical. And the demand of patients for holistic health care cannot be ignored. The disorder or lack of balance in the biological components of the person (curing) has moved to include a concern for balance between mind and body (healing). The distinction between disease and illness plays a role here. When the harmony of body is broken, a person is diseased, but illness arises when disharmony exists between mind and body. When a person cannot find meaning in life, that person is unhealthy. Thus, medical care includes a concern for the spiritual.                   

Defining Spirituality

What exactly is spirituality? The word comes from the Hebrew ruah or the Greek pneuma or the Latin word spiritus meaning breath. Breath is associated with life, so literally, spirituality is ‘breath of life.’ Spirituality is an existential term. It quickens and gives life. According to George Drazenovich, the phenomenological or existential context of spirituality is the preferred one for understanding spirituality in our post-modern world.^[v] Religion, on the other hand, is from the Latin word religare meaning ‘to bind fast’. Religion and spirituality are not the same thing. Religion is but one of many connectors that can be welded to the spiritual drive within psyche. What does the literature say about spirituality? The 2705 member Association for Spiritual, Ethical, and Religious Values in Counselling (ASERVIC) proposes the following definition of spirituality:^[vi]

Spirit may be defined as the animating life force, represented by such images as breath, wind, vigor, and courage. Spirituality is the drawing out and infusion of spirit in one’s life. It is experienced as an active and passive process. Spirituality is also defined as a capacity and tendency that is innate and unique to all persons. The spiritual tendency moves the individual towards knowledge, love, meaning, peace, hope, transcendence, connectedness, compassion, wellness, and wholeness. Spirituality includes one’s capacity for creativity, growth, and the development of a value system. Spirituality encompasses a variety of phenomena, including experiences, beliefs, and practices. Spirituality is approached from a variety of perspectives, including psychospiritual, religious and transpersonal. While spirituality is usually expressed through culture, it both precedes and transcends culture (page 6).

Several characteristics that emerge out of the counseling view of spirituality are echoed by the nursing perspective. Elizabeth J. Taylor (2002) provides a good sampling of these views.^[vii] Spirituality  is seen to be (1) a life principle, (2) God (or Higher Power) within us, (3) an innate force, (4) a vertical/horizontal tendency, (5) and a search for meaning. Taylor’s list of spiritual characteristics includes  reference to self, others, nature, and God/Life Force/Absolute/Transcendent. While each of these descriptors provides insight, the literature suggests that spirituality is too complex define. An electronic search of ‘spirituality and health’ generates 2,570,000 hits. The term is used widely, but no single definition prevails. The Association of American Medical Colleges offers this broad definition of spirituality:^[viii]

Spirituality is recognized as a factor that contributes to health in many persons. The concept of spirituality is found in all cultures and societies. It is expressed in an individual’s search for ultimate meaning through participation in religion and/or belief in God, family, naturalism, rationalism, humanism, and the arts. All of these factors can influence how patients and health care professionals perceive health and illness and how they interact with one another (1999: 25-26).   

To compound the problem, we do not have an established procedure for administering spiritual care. The objective is not accomplished by downloading it to a hospital Chaplain. A team effort is required to deliver spiritual care. We need agreement on a practical vision of what it means to be a person, an inclusive description of spirituality, and a guide for making spiritual connections. This paper offers suggestions on these issues.  

Nursing descriptions of spirituality include five central themes: (1) spirituality is an innate tendency towards meaning, (2) expressed in the experience of the horizontal (3) but driven by the power of the vertical (4) to attain unity, truth, and goodness (compassion) (5) spirituality is expressed in four areas of activity taking place (i) at the level of self (ii) other persons (iii) the natural environment (iv) and the unseen order. The push/pull of spirituality as tendency is ascribed to God, or Higher Power. (But it can also be driven by evil). I use the term ‘Sacred’ since it is more inclusive. It encompasses the denominational view of transcendence as easily as the Eastern view of the All. A belief in the existence of the Sacred also allows for the denial of God.  In light of this, it seems possible to suggest that spirituality is ‘a tendency towards the Sacred”.  Spirituality arises out of a relationship between an innate tendency to seek meaning and the Sacred. The presence of the Sacred in the relationship conveys a sense of belonging to something greater than oneself. The movement towards the Sacred promotes health: the harmony or integration of mind and body. Sacred food exists in the relationships that make us personal.       

The challenge is to find the presence of the Sacred when life has lost its meaning. How does someone find meaning when life is coming to an end? The literature on palliative care suggests that the denial of death is a way of conserving meaning when meaning is lost. As patients take an inventory of life, they wonder why this loss is happening to them, and worry about being at fault for dying. Some individuals view personal death as punishment from God. The terminally ill raise questions about the afterlife, and wonder how loved ones will fare off in their absence. Add to this the indignities of wasting away, the inability to even go to the bathroom alone, or bathe. The challenge facing care givers is to help the patient find (the Sacred) meaning in the midst of emptiness. How does a nurse advocate for the spiritual needs of a dying patient? When Reverend Neil McKenna, Chaplain at the Cape Breton Regional Hospital, discusses these issues in my Spirituality and Health courses, he suggests that we begin with an inventory of our own spirituality. We cannot do for others what we cannot do for ourselves. McKenna examines six basic areas: (i) what gives meaning in my life? (ii) what are the beliefs and values that are most important in guiding my life? (iii) what does the word religion mean to me? (iv) what does the word spirituality mean to me? (v) how might a serious/life threatening illness change the way I find meaning, values or beliefs? (vi) and what spiritual resources do I bring to my work as a nurse or counselor? (e.g. from my religious background, spiritual experiences, and insights from personal suffering or grief). These questions  provide a framework for the care giver, an informed way of advocating for a patient’s spiritual needs. In my classes, the objective is accomplished by keeping a spiritual journal, a daily log in which nursing students enter their personal experiences of the spiritual. (The journal is confidential, I get to see that it’s done, not what goes into it). Having conducted an inventory of his or her own spirituality, the care giver can now focus on the needs of the patient. The nurse helps the patient identify blocks in the tendency towards the Sacred.

The patient that is suffering needs to find meaning in that suffering before healing can take place. In other words, the patient/client must want to move ahead. The nurse can assist the patient find meaning by being compassionate. The nurse does not experience the patient’s pain as such. Rather, compassion is the ability to suffer with someone, to help them find meaning when a source of meaning is gone. Compassion is at opposite ends of the mind-body split since it views the other as being an extension of self. Matthew Fox (1979) puts it succinctly;^[ix]

...in loving others I am loving myself and indeed involved in my own best and biggest and fullest self-interest. It is my pleasure to be involved in the relief of the pain of others, a pain which is also my pain and is also God’s pain (p. 33).

To be one with others is to share hope with them. A regular guest lecturer in my ‘Spirituality and Health’ classes at UCCB, David Macginley, Chaplain, hematology and oncology, Q.E. 11 Hospital, Halifax, NS, has found that one of the most important gifts a nurse brings to a patient is to be real.  The nurse brings compassion, joy, hope, and the promise of quality life to the patient, but does so from the point of view of the patient’s reality. These gifts mirror the patient’s own search for meaning. At that point, a bond (compassion) is established between them. The tendency towards the Sacred can be likened to an instinct, though it is not an instinct because it is subject to the scrutiny of reason. Reason examines the push/pull of the attraction while the will gives the command to use whatever resource is required to attain that good as understood by the intellect. However, the tendency towards the Sacred can be misled by the attraction of evil. Spirituality can go sour by giving to something material the primacy that belongs to the Sacred. A Chaplain can help a patient sort this out. More on this later.  

The second point to be made about spirituality is that the search for meaning takes place through relationships. The traditional view of the person as human being is an abstraction that limits the search for the expression of spirituality. The time is ripe for a change of heart. Rather than think of a person as an entity that has relationships, why not reverse the process and think of persons as the output of relationships. While we are born human, we are not equally personal. We become personal as a result of associations taking place at three fundamental levels. So we need to express spirituality in the language of relationships. First, we are the output of relationships taking place at the level of an interior life. Second, we are the output of relationships taking place with other persons. Third, we are the result of relationships taking place at the level of the natural environment. More is said about each category in the spiritual assessment plan. To be persons as the output of relations is to suggest that we cannot exist in the absence of associations. The pretense that a self exists outside one or more of these associations is a remnant of naturalism. No one exists without all of these relationships. There is no self or ‘I’ in the absence of one or more of the associations that constitute persons. The name I reserve for this concept is the person-making process. We are the output of associations, some freely entered into, others thrust upon us since before birth. While we do not choose our parents, place of origin or early childhood acquaintances, we can make changes in some of these associations as we mature.   

The current definitions of spirituality include reference to relationship with God or a Higher Power but they place the presence of that Power beyond relationships taking place at the level of inner self, others, and the environment. I have some philosophical problems with creating a separate (fourth) category for the God experience. First of all, human reason makes use of the principle of sufficient reason to make sense of things. But that principle is limited to the natural environment. We cannot apply it to the unseen order since that realm lies beyond logic. Second, and more importantly, we do not experience the Sacred except in this world. The point is that experiences of the fourth kind are manifest in the person-making process. Each of these associations expresses a necessary and sufficient condition of being a person in tension towards the Sacred.

The three faces of the person-making process manifest the presence of the Sacred. These faces are interconnected so the following specification is an abstraction: (1) The inner self refers to associations taking place at the level of psyche such as states of consciousness, affective states, spiritual, and religious beliefs. We align ourselves with these states, not only to feel good about ourselves, but also to empower or dis-empower others and nature. (2) The social self refers to other persons. We do not say like Descartes “I think, therefore, I am” but rather “others exist, therefore, I am”. How I feel about myself translates into how I feel about other persons. The patient that expresses anger towards the nurse is expressing a loss of meaning. The unity that characterizes a healthy social self is broken by disease and illness. The patient feels inadequate because of the social alienation taking place in the confines of a hospital room. One suggestion for the social self spills over into the environmental self, namely, fine tuning the patient’s hospital environment.  The more the hospital environment resembles the patient’s familiar space, the greater the ease of inducing holistic healing. For instance, each hospital room can have a cork board space next to the patient’s bed where pictures of the family, significant others, including pets can be posted. In addition, external support systems are an integral part of the social self. They provide an opportunity for patient/client to share feelings with a group of like minded individuals. The indignities expressed by the ALS network at Sue Rodriguez’ search for assisted suicide is a case in point. They were angered because they were left out of the equation. Further, support groups can function as extended family, even in cyberspace. For example, individuals suffering from COPD can be housebound because of oxygen related needs. But they rely heavily on a support system in cyberspace where they can meet and greet. (3) The third arm of the person-making process is the natural environment (including the hospital room as discussed above). Again, no dualism exists between the environment and ourselves. We are not outside that environment looking at nature, but we are that very environmental being looking at itself. The geography of place plays a critical in the holistic formula.

In sum, the existence of a self, ‘I’, or ego outside relationships is a remnant of Cartesian dualism. The sooner we incorporate defining relationships into the definition of being a person, the sooner we can get on with holistic healing. To do otherwise is to commit  metaphysical suicide. 

The next observation to make about spirituality is that as tendency it can take a turn for the dark side of life. The spiritual tendency towards the Sacred is not silenced though it can be put on a bad diet of negative social and environmental connectors. Even brain chemistry can turn on a patient. The dark side of relationships seeks disunity, the result of inferior welding. The spiritual longing for the Sacred is active when it pushes us to search for meaning, or passive when pulled by an external stimuli. The push/pull of spirituality is a movement towards whatever the individual values as supreme at the time, including evil. We gradually develop moral habits towards good and evil. The term ‘evil’ is taken to refer to whatever promotes disunity (disharmony, dualism, division) in the life of a person. Thus I align myself with disunity when I choose to dis-empower others, pollute the natural environment or divide my inner self though acts of self-hate, addiction, and despair. Addiction is a misguided way of coping with negative relationships. It is animated by relationships that promote disunity, and lack of compassion. The existential fact of human freedom is simultaneously an opportunity for personal growth, but it can also be used to bring on division and death. Freedom comes with awesome responsibilities. The spiritual tendency towards the Sacred generates a profound restlessness within us to do good and avoid evil. Doing good helps us find meaning in life. It generates a sense of peace, unity, truth, and happiness. And spirituality can go sour. But none of this happens outside of relationships. 

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. 

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.