Experienced healthcare workers can often effectively manage the difficult physical symptoms that accompany the dying process, but the management of suffering with its complex spiritual components poses new and unique challenges. Even the rare healthcare worker, who can assess and understand spiritual pain, is often at a loss to know what exactly to do with the information once it is obtained. In CareMatters #16 we defined spirituality, discussed its importance within the hospice framework, and finally, we addressed the spiritual needs of dying patients. In this CareMatters, we will be discussing practical strategies and interventions for comforting patients who are suffering spiritually.
The Goal of Hospice
Cicely Saunders, the founder of the modern hospice movement, declared that the goal of hospice is to relieve suffering. She then went on to define suffering as total pain: the pain of the physical, social, emotional, and the spiritual. While, in some ways, physical, social and emotional pains are more easily identified and treated, spiritual pain is more challenging. In addition, human suffering is rarely isolated to one dimension but “leaks” into all of the human dimensions of a person’s suffering: physical, emotional and social. For example, the angst caused by spiritual pain can aggravate physical pain. And unrelieved pain can magnify spiritual pain. Therefore, it is important that all clinicians have a basic understanding of how to treat spiritual pain.
General Interventions to Alleviate Spiritual Pain
These interventions address the individual as a unique person who is suffering in the present moment. It is important for the clinician to also be present in the moment if he is going to help the patient. Being present physically means sitting next to the patient at the same eye level. Being present emotionally means listening carefully and trying to understand what the patient is feeling. This often involves reading between the actual words and watching facial expressions and gestures. Being present spiritually is the mindset that opens the door to the other interventions. In general, emphasis should be placed on interventions that:
- Treat distressing physical symptoms
- Decrease the patient’s and family’s sense of isolation
- Provide patients and families with a safe place to voice their sufferings
- Help patients and families develop a sense of meaning, purpose and self-worth
- Help patients and families strengthen their inner resources
- Connect patients and families with local clergy and hospice chaplains
Specific Interventions to Alleviate Spiritual Pain
Most experts view spiritual development as being dependent on four inter-related dimensions:
- Community: Spiritual development rarely occurs in isolation. In fact, spiritual growth typically occurs within the context of human relationships and community.
- Meaning: Spiritual development usually occurs within the context of a greater journey or search, such as one’s quest for meaning and purpose.
- Religious needs: Religious teachings, beliefs, and dogma often shape the methods and ways that a person conducts his or her search for meaning. Therefore, religious traditions and culture can provide concrete interventions for alleviating spiritual suffering.
- Inner resources: Spiritual disciplines and religious teachings often enhance our capacity to transcend life’s difficulties. Therefore, any practice or activity that inspires, motivates, or compels a person to hope or trust or gives peace is a spiritual intervention.
Once you appreciate these four dimensions, it becomes fairly obvious that spiritual pain is often very personal and intimate…and, therefore, interventions need to be specific and unique for each suffering person.
Interventions to Alleviate Spiritual Pain Related to Community Issues
Spirituality is often practiced in community settings such as a church, synagogue or mosque. Each setting has its own cultures and practices and these can be a source of strength or a source of anguish. Sometimes spiritual pain is actually caused by the patient’s relationship to the spiritual community: patients may feel abandoned, betrayed or isolated. Others may have withdrawn themselves from spiritual support communities and this becomes a source of pain as the support is now desired and needed. Below is a list of interventions that revolve around community issues:
- Encourage life review with an emphasis on religious and spiritual experiences
- Explore the nature of the patient’s spiritual support system – does it relieve pain or is it a cause of pain?
- Support ways to strengthen past and present spiritual support systems
- Support meaningful relationships with significant others (friends and family)
Interventions to Alleviate Spiritual Pain Related to Issues of Meaning
Because a person’s religious beliefs (or lack thereof) about suffering, death and the afterlife can profoundly affect the process of dying, healthcare workers should understand some basic beliefs of the major religions in their area. It is important, however, to recognize that generalizations about any religion are problematic as there are many variations within religious subgroups. The observation of holy days, dietary restrictions, daily prayers, modesty requirements and other important religious traditions give value and dignity to the patient when these are honored by clinicians. Here are some examples of interventions that focus on specific religious needs. For most of these, the hospice chaplain will need to play the major role:
- Short prayers that focus on peace, relief, and reconciliation
- The sacraments of baptism, marriage and reconciliation
- Confession of sins, absolution of sins and the asking of forgiveness
- Singing religious songs and hymn
- Devotional practices such as meditation, prayer, reading of religious scriptures
Interventions to Alleviate Spiritual Pain Related to Inner Resource Issues
Taping inner resources seems, at first blush, to be the opposite of taping spiritual resources as most people think of spiritual resources as coming from an external source. However, this dualistic view is too simplistic. Spiritual disciplines and religious beliefs often enhance our inner capacity to absorb life’s blows and difficulties. Therefore, tapping the inner resources that increase faith, hope, peace, and love are spiritual interventions — here are some examples:
- Encourage life review with an emphasis on the theme of coping
- Help patients identify elements and activities in the past that have increased faith, hope, joy, peace and love
- Help patients identify what their sources of strength have been in the past
- Encourage use of relaxation, poetry, and music that focuses on healing rather than on physical cures
The Way Up Spiritually is Often Down
It is important for clinicians to realize that the way up, spirituality speaking, is often down. Generally, this is not true in the other dimensions of suffering. In other words, when one comes face to face with a patient who is experiencing deeply troubling spiritual pain, the clinician is likely to experience an initial sense of dismay or helplessness and natural the tendency is to avoid such feelings and change the topic. The patient frequently feels the same urgings. But it is often from that painful sense of helplessness that spiritual healing begins. I remember a patient who expressed to me that he considered himself a murderer because of something he did decades previously. My initial reaction was to blurt out, “You were young. You have lived a good life since — forget about it.” Of course, this advice was foolish and ignorant – he had been trying to forget about it for over thirty years. Only when we went into the depths of his pain – into his confession – did that man’s healing occur. Often, the most effective healing intervention for spiritual pain is simply acknowledging the presence of that pain and listening with empathy to the patient’s life story.
Spiritual pain is a challenging symptom, which can affect all of the human dimensions of suffering: physical, emotional, and social. Hospice, with its philosophy of addressing all of these dimensions with an interdisciplinary team is uniquely poised to help patients and caregivers cope and handle this pain. Referring a patient to AseraCare Hospice is the best way to ensure that your patient will receive the best end-of-life care possible.