4/8/2014 My Grandfather’s Blessing HEALING SUFFERING A Clinical Pastoral Response to Suffering Presented by Paul Murphy, MA, BCC Lori Lind, RN, MS May 17, 2014 Agenda Weaving Several Threads • First hour: Spirituality, Suffering and Healing • Clinical – Lecture: Defining the Situation – Case Study: Metaphorical Listening • Pastoral • Second Hour: The Clinical Process and Meaning Making • Inspirational – Lecture: Suffering and the Need for Meaning • Practical – Case Study: Treating Suffering Related to Meaning • Psychological • Third Hour: Beliefs, Values and Purpose – Lecture: Spiritual Goal Setting • Theological – Case Study: Treating Suffering Related to Purpose • Personal • Fourth Hour: The Clinical Chaplain: Spiritual Specialist • Professional – Lecture: Spiritual Interventions • Catholic Perspective – Case Study: Treating Suffering Related to Relationship 1
4/8/2014 Spirituality • Spirituality is the unifying force or vital principle of a person that integrates all other Spirituality, Healing and dimensions of the human being. Suffering • Spiritus is Latin for breath. • Spirituality has the same root as words related to breathing (e.g.: respiration, inspiration and expiration.) Spirituality and Life Definition of Spirituality “Spirituality is the aspect of humanity “Life is a God ‐ given opportunity that refers to the way individuals to become who we are, seek and express meaning and to affirm our own true spiritual nature, purpose and the way they to claim our truth, experience connectedness to the to appropriate and integrate the reality of our moment, to self, to others, to nature being, and the significant or sacred.” but, most of all, to say “Yes” to the One who calls us the Beloved.” (Puchalski, C. Making Healthcare Whole , p. 25) Henri Nouwen, Life of the Beloved 2
4/8/2014 Definition of Spirituality Definition of Spirituality Spirituality is that which animates one’s being Spirituality is that which animates one’s being with meaning, purpose and relationship. with meaning, purpose and relationship. Meaning: The way one organizes knowledge and Meaning: The way one organizes knowledge and experience. Meaning’s ultimate goal is Wisdom. experience. Meaning’s ultimate goal is Wisdom. Purpose: The goal of one’s life and the values Purpose: The goal of one’s life and the values one lives by. one lives by. Relationship: Connection to the Divine, to others Relationship: Connection to the Divine, to others and to self. Relationship is expressed through and to self. Relationship is expressed through Compassion. Compassion. Whole Person Care Characteristics of Spirituality • Spirituality is shown through peace, joy, • Whole person care addresses: happiness, truth, honor, dignity, respect, responsibility, truth, kindness, patience, generosity, humility, appreciation, caring, – Physical needs service, healing, hope, endurance, resilience, – Psychological needs resourcefulness and beliefs. – Spiritual needs 3
4/8/2014 Medicine and Spirituality Medical Model • Focus of Medicine : the physical dimension, • Strength of Medical model: ease physical pain, find a cure, specific – Evidence based: most current, relevant practice – Combines research and practical experience measurements and tests – Powerful pharmacologic and surgical interventions to cure illness • Focus of Spirituality : the spiritual dimension, • Limitations of Medical model: ease spiritual distress, seek spiritual healing, – May not address the cause of the illness – Focus on treatment rather than prevention deal with individual situations, level of – May not account for patient values, social and mystery environmental factor in disease. Spirituality Model The Spiritual Dimension “ I am not a mechanism, • Strength of Spirituality model: an assembly of various – Beliefs effect compliance and outcomes parts. And it is not – Reduce depression and anxiety; increase hope and trust because the mechanism is – Faith activates natural systems of healing, i.e. placebo working wrongly, that I a effect ill. I am also ill because of • Limitations of Spirituality: wounds to the soul, to the – Very individualistic, not quantifiable or measurable deep emotional self…” – Religious beliefs about judgment and punishment – Spiritual values may differ from healthcare provider D.H. Lawrence 4
4/8/2014 Addressing Spiritual Need Spiritual Screening In healthcare setting, spiritual need is • Basic inquiry; quickest, meets requirements addressed in three ways: • Denominational preference • Importance of religion and spirituality in one’s – Spiritual Screening at time of coping with illness admission • Chaplain visit? – Spiritual History – Spiritual Assessment Spiritual History Spiritual Assessment • Better level of assessment • Deepest level of assessment • In ‐ depth conversation with a certified chaplain • F.I.C.A. Model: • Seek to identify issues that are causing suffering (spiritual distress) for patient – F – faith What is your faith tradition? – I ‐ important How important is your faith to you? • Apply a clinical method for assessment. – C – church What is your faith community? – A – address Are there spiritual needs to address? Dr. Christina Puchalski 5
4/8/2014 Spirituality and Religion Why Do Spiritual Assessment? • Many patients are religious and religious beliefs • Spirituality is an innate, universal aspect of help them cope. being human. • Religious beliefs influence medical decisions especially when patient is seriously ill. • Religion is one form of expressing spirituality; • Religious beliefs and activities are related to characterized by specific beliefs, practices and better health and quality of life. rituals common to a faith community and how • Many patients want their spiritual needs it relates to the Divine. addressed. • There is a long historical relationship between • Chaplains navigate different religious religion, medicine and healthcare. traditions by finding the universal concepts Harold Koenig, M.D. found in all religions. Spirituality and Religion Spirituality and Religion • Sacredness of creation • Public Ministry: • Source of strength, meaning and coping – Variety of expressions • Ultimate destination and way to reach it – Inclusive (non ‐ judgmental) • Positive relationship to physical health – Patient determines way to support • Motivation for change • Denominational Ministry: • Connection to God – Common practices • Past, present and not yet – Common doctrine – Common form of prayer and support 6
4/8/2014 Spirituality and Science Spirituality and Science • Ancient psychology studied the mystery of the • The Age of Enlightenment separated science soul. from religion. • Modern psychology studies the mind. • Religion seen as superstitious and non ‐ rational. • Science is analytical, measurable, repeatable and verifiable. • Science seeks proof. Religion based on faith. • Spirituality is a different kind of knowledge: • Atheists and agnostics want proof for God’s obvious and mysterious, universal and existence. personal, natural and supernatural, easy and • Atheists have problems with organized religion challenging. but have a spirituality based on human values. Suffering and the Human The Elephant in the Room Condition • Cassel defined suffering as a distressful state • We want to ignore it induced by the possibility of losing one’s sense of living as an integrated being. • We want it to go away • People in pain suffer when they feel out of • Yet, suffering is critical to the development of control, when the pain is overwhelming, when personal wisdom and the source of pain is unknown, when the compassion and the meaning of the pain is dire or the pain is fulfillment of our apparently without end. human potential. • Illness = “dis ‐ ease”; Suffering = “dis ‐ integration” 7
4/8/2014 Suffering and the Human Suffering = Spiritual Distress Condition • To understand suffering means to • Spiritual distress is a clinical term that refers to understand what it means to be human. the disruption of the life principle that • Two essential characteristics of humanness: integrates and transcends one’s biological and – Orientation to the transcendent psychological nature. – Being ‐ in ‐ relationship • All suffering is an experience of finitude. • Human beings are susceptible to suffering • Spiritual maladies include fear, depression, whenever they experience pain because pain loneliness, existential anxiety, guilt, anger, has a way of focusing their attention on their meaninglessness, loss and despair. vulnerability. Sulmacy, The Healer’s Calling Suffering Suffering • Different levels of suffering: • Suffering is soul pain. – Physical • Suffering is caused when a person’s sense of – Moral meaning, purpose or relationship is threatened or overwhelmed. – Psychological – Spiritual • Suffering is eased when beliefs and values are remembered and a new equilibrium is established Etymology: the word “patient” comes from the Latin patiens which means “one who suffers.” 8
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