The Response to Spiritual
Pain
October 5, 2012
I have no disclosure nor conflict of
interest
Pain insists on being attended to.
God whispers to us in our
pleasures, speaks in our
conscience but shouts to us in our
pain. It is His megaphone to rouse
a deaf world.
C. S. Lewis: The Problem of Pain
Introduction
• Why?
History
• Ancient issue concerning the problem
of Pain and Suffering
• Pain and suffering was considered not
separate issues
• They came to be dealt with as separate
• Now we see they can be related
History
• Can they be related?
– Medicine is the last Scientific Discipline to
let go of the demand of total Empirical
Demands.
– We still have the same issues and
philosophical problem
– Problem of perception
So even with better physical treatments
we are still dealing with the same issues
concerning the connection of pain and
suffering!
Then maybe it may benefit us to examine
the Psychosocial-Spiritual Aspects of Pain
Management.
Definitions - Pain
• Pain is "an unpleasant sensory and emotional
experience associated with actual or potential
tissue damage, or described in terms of such
damage." It is the feeling common to such
experiences as stubbing a toe, burning a
finger, putting iodine on a cut, and bumping
the “funny bone".
Wikipedia
Definitions - Pain
• Most pain resolves promptly once the
painful stimulus is removed and the
body has healed, but sometimes pain
persists despite removal of the
stimulus and apparent healing of the
body; and sometimes pain arises in the
absence of any detectable stimulus,
damage or disease.
Definitions - Pain
• Pain is the most common reason for
physician consultation in the United
States. It is a major symptom in many
medical conditions, and can significantly
interfere with a person's quality of life
and general functioning. Social support,
hypnotic suggestion, excitement in sport
or war, distraction, and appraisal can all
significantly modulate pain's intensity or
unpleasantness.
Definitions - Suffering
The word suffering is sometimes used in
the narrow sense of physical pain, but
more often it refers to mental or
emotional pain, or more often yet to
pain in the broad sense, i.e. to any
unpleasant feeling, emotion or
sensation.
Spiritual distress is a disturbance in a
person's belief system. As an approved
nursing diagnosis, Spiritual Distress is
defined as "a disruption in the life principle
that pervades a person's entire being and
that integrates and transcends one's
biological and psychological nature.
DEFINITIONS
• RELIGION
A particular system of faith and worship,
assimilated to help make sense with life here
and after. It is thought of in a community
sense.
DEFINITIONS
• SPIRITUALITY
A system of belief about the way life is or should be
that each of us have.
Our way of viewing the world and our relationship
to it that brings order into the chaos of living and
helps us cope with the uncertainties and distresses
of life.
Science, philosophy, religion, pragmatism, and
many other belief systems are adopted and utilized
for this purpose.
DEFINITIONS
SPIRIT:
The word “spirit” is a translation of the Greek word
pneuma, which means “wind” or “breath.”
Webster defines spirit as “an animating or vital
principle held to give life to physical organisms”
and “the activating or essential principle
influencing a person.”
DEFINITIONS
DISEASE
The Oxford Dictionary defines disease as “an unhealthy
condition caused by infection, or diet or condition of life,
or inherited.
When humans experience a disease, crisis
event their ordered world and their sense of
vitality is powerfully shaken if not shattered.
This event leaves them “breathless” or
without an animating or activating energy. It
is as if the “wind” has been knocked out of
them with an accompanying sense of betrayal
by life. In this context of experience humans
are confronted with a situation where the
potentiality for both positive and negative
outcomes is greatest.
Chronic Pain
and Suffering
HYPOCRITES –
GOALS OF MEDICINE
Doing away with the suffering of
the sick lessoning the violence of
their diseases and refusing to treat
those who are over mastered by
their diseases realizing that in such
cases medicine is powerless – but
we should treat those who are
powerless.
AMA – 1846 – EOL CARE
A physician ought not to
Abandon a patient because the
Case is deemed incurable; for his
attendance may continue to be highly
useful to the patient, and comforting
to the relatives around him, even in
the last period of a fatal malady, by
alleviating pain and other symptoms,
and by soothing the mental anguish.
First Code of Medical Ethics - AMA
Preferences & Alternatives
• DEFINITIONS
– Palliative Care: 2000 World Health
Organization – Palliative care is a medical
approach that improves the quality of life
of patients and their families facing the
problem associated with life-threatening
illness, through the prevention and relief
of suffering by means of early
identification and impeccable assessment
and treatment of pain and other problems,
physical, psychosocial and spiritual.
Preferences & Alternatives
• DEFINITIONS
– Holistic Care: Defined by
www.holistichelp.net – It’s a wellness
approach that addresses the body, mind,
and spirit or the physical, emotional and
spiritual aspects of an individual. This is
best achieved in the context of team care.
Pts. Have complex needs and it takes a
team of professionals and volunteers to
help meet them all. The pt. may not label
their problems as physical, emotional or
spiritual, but is often desperately seeking
simultaneous help on all these fronts.
Victor Frankl “Man’s Search for Meaning”
“By ‘spiritual’ I understand the essence of what it
means to be human. Spiritual issues are issues
of the soul and concern our deepest values and
meaning.” Michael Kearney
Someone has said that Spiritual Pain is like
Supreme Court Justice Powell’s definition of
pornography: “ I know it when I see it.”
Spiritual pain occurs when there is an event that
violates or perceives to violate the core values,
beliefs, or needs of the person.
GOALS OF MEDICINE
CURE
CONTROL
PALLIATIVE
VERY END OF LIFE
LIFE HAS MEANING
This holistic health approach says that health
depends not only on genetics, and
biochemistry but also on physical, emotional,
mental, environmental, nutritional, and even
spiritual factors.
The Holistic Model
The person does things to
compensate for the environment
Biomedicine has been characterized by
mechanistic notion that the body is as a
machine composed of separate parts – and
reductionism.
The reduction of illness to a set of physical
symptoms. Mechanism and reductionism
tend to separate diagnosis and treatment
from the patients subjective and social
experience of disease;
This distances the patient from caregiver and
severs personal meaning from the process of
healing.
Spiritual Issues
Identity
Connectedness
Values
Meaning
Purpose
Just as spiritual issues affect
everyone so too a patient’s
‘spiritual pain’ is the concern of
each member of the
multidisciplinary caring team.
What can one hope to achieve for and
with someone in spiritual pain?
Nietzsche writes “someone with a why
can bear any how.”
Perhaps then one might describe the task here as
enabling that individual to recognize their unique and
individual why, to recognize the meaning that ‘connects’
for them, knowing that this has the potential to
transform their pain. Afterwards certain aspects of total
pain may still be there or even worsen, and a majority of
individuals will experience feelings of sadness and
grieving. However, the pain is somehow now no longer
the problem it was before. Where there was a
restlessness and an agitation there is now a ‘knowing
that it is OK’, a sense of being held, which is not a
rationalization but has such qualities as quietness,
broadness and a light solidity.
Michael Kearney
The balm (salve) for spiritual pain is not
something I have out here, like a couple of
aspirins, which I can give to a patient for their
pain. No, the balm for spiritual pain is to be
found in the experience of the pain itself.
I suggest we need to find ways to enable the
individual to wait in the troubled waters of their
experience, even to let go more deeply to that
experience and I am not sure this possible to do
this without in some way entering those waters
ourselves.
The palliation for spiritual pain isn’t elimination
but integration. The painful experiences in our
lives inevitably become the painful memories and
we can’t change that: what we can change is
how we remember them and integrate them.
Physical pain itself can be exacerbated by non-physical causes
such as fear, anxiety, grief, unresolved guilt, depression, and
unmet spiritual needs
Likewise, the inability to manage physical pain well can be
due to emotional or spiritual issues
Persons may refuse pain medication due to fear or because
they wish to be alert to interact with loved ones or because
they believe they deserve to suffer
Unrelieved physical pain, among other symptoms, may itself
cause emotional or spiritual suffering
Finally, some emotional or spiritual suffering — especially in
certain cultures — may manifest itself as physical pain or
other physical maladies
Spiritual influences on physical pain
Spiritual frameworks and religious traditions
influence how persons interpret and
experience physical pain
How mind, body, and spirit are understood in
relationship to each other and, in some cases,
in relationship to a deity or deities is
important to understand
Usually this framework is broader to include
suffering of all kinds, whether its cause is
physical or due to other causes
Cultural interpretations of pain and suffering may conflict with
goals of palliative care
Sometimes, these cultural and religious interpretations of
pain and suffering can conflict with the stated goal of
palliative care: to relieve pain and suffering
This is why a holistic, interdisciplinary assessment of pain is
necessary
Plans to manage pain pharmacologically often fail or patients do
not comply with these plans when the larger spiritual framework
is not adequately understood and integrated into the plan of care
Spiritual practices may help in the management of physical pain
Increasingly, medical staff recognize the palliative nature of
religious and spiritual practices
Some practices that have been proven to help in the
management of physical pain include:
Prayer
Relaxation techniques
Chanting
Ritual cleansing
Acts of atonement
Shamanic treatments
Acupuncture
Herbal remedies
Spiritual pain and suffering may be caused by physical
pain and other symptoms
Loss of personhood
Despair
Feelings of abandonment by God
Example 1:
Ann is a strong Christian and a believer that God
rewards those who do the right thing and punishes
sinners. Then one day she is told by here doctor that
she has incurable cancer. This does not fit her belief
about God and she now wonders if God exists.
Example 2:
Cathy is another person who does not necessarily
believe in God but does believe that karma dictates that
evil will be punished. She is then the victim of a brutal
robbery and her assailant is acquitted on a technicality.
While her physical wounds have healed, her spiritual
wound continue and cause her to wonder if there is any
point in going on.